Individual
LATERICA MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1513 LINE AVE STE 225, SHREVEPORT, LA 71101-4621
(318) 754-3890
Mailing address
416 JACKSON AVE, RUSTON, LA 71270-5746
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/14/2017
Last updated
03/14/2017
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