Individual
CELIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 N MARKET ST, SHREVEPORT, LA 71107-6537
(131) 862-6559
(318) 626-5597
Mailing address
1500 N MARKET ST, SHREVEPORT, LA 71107-6537
13186265597
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2203782947
LA
Other
Enumeration date
08/07/2017
Last updated
08/07/2017
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