Individual
SAMARIA RANDLE TISBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1632 SHEPHERD DR, SHREVEPORT, LA 71107-4955
(318) 415-8414
Mailing address
1632 SHEPHERD DR, SHREVEPORT, LA 71107-4955
(318) 415-8414
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/03/2018
Last updated
01/03/2018
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