Individual
FANETTA MAQUAIL HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
458 HERNDON ST, SHREVEPORT, LA 71101-4859
(318) 429-6938
Mailing address
8501 MILLICENT WAY, SHREVEPORT, LA 71115-2237
(662) 312-5913
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC7978
LA
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
PLC7978
LA
Other
Enumeration date
07/29/2019
Last updated
09/15/2022
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