Individual
SHASTA PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1406 ESPLANADE AVE, NEW ORLEANS, LA 70116-1803
(504) 304-4097
(504) 218-7962
Mailing address
4516 PERLITA ST, NEW ORLEANS, LA 70122-1849
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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