Individual
MS. MIA DESHAWN WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
(915) 742-4890
Mailing address
501 EAST STONER AVENUE, SHREVEPORT, LA 71101
(318) 221-8411
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
62608
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
62608
ASSOCIATES OF SOCIAL WORK BOARD
TX
Enumeration date
10/29/2015
Last updated
09/22/2023
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