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1144754482
DOMINIQUE ELLISON
SHREVEPORT, LA
NPI
1144754482
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2017-04-13
Last Update Date
2017-04-13
Business Address
-- DOMINIQUE ELLISON
301 DALZELL ST
SHREVEPORT, LA 71104-2431
Phone number: 318-200-9156
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Mailing Address
-- DOMINIQUE ELLISON
301 DALZELL ST
SHREVEPORT, LA 71104-2431
Phone number: 318-200-9156
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