Individual
ALYSSA FASOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2924 KNIGHT ST STE 420, SHREVEPORT, LA 71105-2413
(318) 210-0587
Mailing address
219 DOGWOOD SOUTH LN, HAUGHTON, LA 71037-8507
(504) 812-8226
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
19064
LA
Other
Enumeration date
01/17/2025
Last updated
01/17/2025
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