Individual
EDWIN JEFFERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1717 MARSHALL ST, SHREVEPORT, LA 71101-4139
(318) 226-9944
Mailing address
6416 JOY DR, SHREVEPORT, LA 71119-5110
(318) 834-9629
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/09/2017
Last updated
11/09/2017
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