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Individual

VICTORIAL RENETT DEAVENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
428 24TH AVE N, COLUMBUS, MS 39705-1945
(662) 241-7097
(662) 245-0155
Mailing address
2525 YOUREE DR STE 100, SHREVEPORT, LA 71104-3600
(662) 241-7097
(662) 245-0511

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
05/25/2017
Last updated
05/25/2017
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