Individual
LATRISHIA GANT JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
543 STONER AVE, SHREVEPORT, LA 71101-4122
(318) 673-9901
Mailing address
543 STONER AVE, SHREVEPORT, LA 71101-4122
(318) 673-9901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/13/2018
Last updated
02/13/2018
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