Individual
CHOCKA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4407
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4407
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11125
LA
1041C0700X
Clinical Social Worker
4746
OR
Other
Enumeration date
07/10/2013
Last updated
03/21/2017
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