Individual
MRS. DEJUANA LACHELLE DANZELL PETTEWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, ASCW, ACHP-SW
Contact information
Practice address
510 E. STONER AVENUE, SHREVEPORT, LA 71101-4295
(318) 221-8411
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-5781
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9900
LA
Other
Enumeration date
07/13/2007
Last updated
03/19/2021
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