Individual
TIFFANY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3510 LINWOOD AVE, SHREVEPORT, LA 71103-4512
(318) 636-4194
Mailing address
3510 LINWOOD AVE, SHREVEPORT, LA 71103-4512
(318) 636-4194
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/06/2016
Last updated
04/12/2016
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