Individual
MR. CHRIS ALAN MICIOTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW LCSW ACSW
Contact information
Practice address
864 OLIVE ST, SHREVEPORT, LA 71104-2159
(318) 222-0759
(318) 221-0216
Mailing address
7505 CAMELBACK DR, SHREVEPORT, LA 71105-5412
(318) 518-0621
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2914
LA
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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