Organization
POSITIVE CHANGE
Active
Organization
POSITIVE CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEESHA DINKINS (BUSINESS MANAGER)
(318) 688-8190
Entity
Organization
Contact information
Practice address
351 W 79TH ST, SHREVEPORT, LA 71106-4819
(318) 688-8190
Mailing address
1100 W 70TH ST, APT 1401, SHREVEPORT, LA 71106-3562
(318) 572-7517
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2395157
—
LA
Enumeration date
12/01/2015
Last updated
12/01/2015
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