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1073766747
REVONDER THOMAS
SHREVEPORT, LA
NPI
1073766747
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: LA 8942)
Enumeration Date
2008-10-28
Last Update Date
2008-10-28
Business Address
-- REVONDER THOMAS LCSW
510 E STONER AVE
SHREVEPORT, LA 71101-4243
Phone number: 318-221-8411
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Mailing Address
-- REVONDER THOMAS LCSW
510 E. STONER AVE.
SHREVEPORT, LA 71101-4295
Phone number: 318-221-8411
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