Individual
SHALIZA TOLLIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 PLUM TREE DR, RAYVILLE, LA 71269-7301
(225) 588-8318
Mailing address
12 PLUM TREE DR, RAYVILLE, LA 71269-7301
(225) 588-8318
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
010217901
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010217901
DRIVER'S LICENSE
LA
Enumeration date
11/04/2016
Last updated
11/04/2016
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