Individual
SHARETHA WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9403 MANSFIELD RD, SHREVEPORT, LA 71118-3815
(318) 861-8938
Mailing address
9403 MANSFIELD RD, SHREVEPORT, LA 71118-3815
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
Other
Enumeration date
09/24/2017
Last updated
09/24/2017
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