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Individual

MRS. JUANITA ROSALYN GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PPS

Contact information

Practice address
4571 N MARKET ST, SHREVEPORT, LA 71107-2917
(318) 424-8973
(318) 424-8739
Mailing address
10669 WILLOW CREEK RD, MORENO VALLEY, CA 92557-2953
(951) 269-7988

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
171M00000X
Case Manager/Care Coordinator
Primary
6010
LA

Other

Enumeration date
04/02/2019
Last updated
11/23/2021
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