Individual
LAVONDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7607 FERN AVE STE 404405, SHREVEPORT, LA 71105-5739
(318) 284-8481
Mailing address
7607 FERN AVE STE 404405, SHREVEPORT, LA 71105-5739
(318) 284-8481
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
005486967
LA
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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