Individual
MRS. KYWANNA SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
2920 KNIGHT ST, SUITE110, SHREVEPORT, LA 71105-2412
(918) 670-7047
(318) 670-7156
Mailing address
2920 KNIGHT ST, SUITE110, SHREVEPORT, LA 71105-2412
(918) 670-7047
(318) 670-7156
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2017
Last updated
05/12/2017
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