Individual
RAVEN JANEEN KING-SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6109 AMBLESIDE DR, SHREVEPORT, LA 71129-7112
(318) 518-3553
Mailing address
6109 AMBLESIDE DR, SHREVEPORT, LA 71129
(318) 518-3553
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
17066
LA
Other
Enumeration date
06/18/2019
Last updated
07/24/2024
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