Individual
DEEANDRIEZ WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3003 KNIGHT ST, SUITE 115, SHREVEPORT, LA 71105-2561
(318) 614-7314
Mailing address
3003 KNIGHT ST STE 115, SHREVEPORT, LA 71105-2561
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PLC9016
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
04/06/2022
Last updated
02/03/2023
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