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1023527843
JENESIS RAQUEL GIBSON
SHREVEPORT, LA
NPI
1023527843
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: LA 6454)
Enumeration Date
2017-09-25
Last Update Date
2017-09-25
Business Address
JENESIS RAQUEL GIBSON LPC
856 TEXAS AVE
SHREVEPORT, LA 71101-3400
Phone number: 318-429-6938
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Mailing Address
JENESIS RAQUEL GIBSON LPC
8706 SAINT VINCENT AVE
SHREVEPORT, LA 71106-5557
Phone number: 225-931-5479
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