Individual
DANTE SAVANNAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2146 PEARL ST, SHREVEPORT, LA 71107-8017
(318) 655-3047
Mailing address
2146 PEARL STREET, SHREVEPORT, LA 71107
(318) 655-3047
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009071719
DRIVERS LICENSE
LA
Enumeration date
04/17/2017
Last updated
10/30/2018
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