Individual
JENITA BLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 CHINABERRY DR STE 900, BOSSIER CITY, LA 71111-2455
(318) 459-6579
Mailing address
4830 LINE AVE # 5764, SHREVEPORT, LA 71106-1530
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
15403
LA
1041C0700X
Clinical Social Worker
Primary
15403
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/24/2019
Last updated
06/30/2023
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