Organization
WK CENTER FOR PSYCHIATRIC SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG J. GAVIN (NETWORK ADMINISTRATOR)
(318) 212-4232
Entity
Organization
Contact information
Practice address
1111 LINE AVE 3RD FLOOR TOWER 2, SHREVEPORT, LA 71101-3981
(318) 716-4610
(318) 716-4690
Mailing address
1111 LINE AVE 3RD FLOOR TOWER 2, SHREVEPORT, LA 71101-3981
(318) 716-4610
(318) 716-4690
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
05/05/2010
Last updated
02/17/2017
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