Individual
SHASTITY CLAIBORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
410 E ASKEW ST, TALLULAH, LA 71282-3706
(318) 574-2320
Mailing address
410 E ASKEW ST, TALLULAH, LA 71282-3706
(318) 574-2320
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
171M00000X
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972980514
—
LA
Enumeration date
06/14/2021
Last updated
06/14/2021
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