Organization
SHELLEY GILDWARG, LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY AMBER STEPHENS (DELEGATE)
(318) 443-9339
Entity
Organization
Contact information
Practice address
5920 COLISEUM BLVD, ALEXANDRIA, LA 71303-3714
(318) 443-9339
(318) 443-9116
Mailing address
5920 COLISEUM BLVD, ALEXANDRIA, LA 71303-3714
(318) 443-9339
(318) 443-9116
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1893412
—
LA
Enumeration date
02/14/2020
Last updated
02/14/2020
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