Organization
SHINING STAR PROFESSIONAL SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AKEE LJ JACKSON LCSW (OWNER)
(318) 795-8055
Entity
Organization
Contact information
Practice address
9050 YOUREE DRIVE, #1004, SHREVEPORT, LA 71115
(318) 795-8055
(318) 635-7100
Mailing address
9050 YOUREE DRIVE, #1004, SHREVEPORT, LA 71115
(318) 795-8055
(318) 635-7100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4322
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1562904
—
LA
01
—
5X968
INDIVIDUAL MEDICARE #
LA
Enumeration date
11/09/2006
Last updated
08/22/2020
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