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Individual

JIMMY LAMAR GIDDINGS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LBSW

Contact information

Practice address
2924 KNIGHT ST STE 436, SHREVEPORT, LA 71105-2431
(318) 272-2320
Mailing address
2114 E MARSHALL AVE APT 202, LONGVIEW, TX 75601-6900
(903) 431-5309

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
21994
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1316398781
LA
Enumeration date
07/03/2019
Last updated
07/03/2019
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