Organization
ROAD TO CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANA L CONVERSE (OWNER)
(318) 470-7730
Entity
Organization
Contact information
Practice address
2620 CENTENARY BLVD STE 204, SHREVEPORT, LA 71104-3350
(318) 470-7730
Mailing address
9019 TOPLECOT DR, SHREVEPORT, LA 71129-5137
(318) 470-7730
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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