Individual
BRENDA J GANTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3400 NATHAN CIR, SHREVEPORT, LA 71108-5343
(318) 686-8995
Mailing address
3400 NATHAN CIR, SHREVEPORT, LA 71108-5343
(318) 686-8995
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
5193
LA
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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