Individual
MR. JAMES MAXIE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA,QMHP-CS
Contact information
Practice address
200 N THOMAS DR, SHREVEPORT, LA 71107-6503
(318) 573-3942
Mailing address
1840 LOGAN ST, SHREVEPORT, LA 71101-2316
(318) 573-3942
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
LA
101YM0800X
Mental Health Counselor
—
LA
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
175T00000X
Peer Specialist
—
—
385HR2055X
Child Mental Illness Respite Care
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
TX
05
—
11023
—
LA
Enumeration date
04/23/2018
Last updated
07/21/2022
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