DOMINIQUE ELLISON

SHREVEPORT, LA
NPI1144754482
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
Enumeration Date2017-04-13
Last Update Date2017-04-13
Business Address
-- DOMINIQUE ELLISON
301 DALZELL ST
SHREVEPORT, LA 71104-2431
Phone number: 318-200-9156
Mailing Address
-- DOMINIQUE ELLISON
301 DALZELL ST
SHREVEPORT, LA 71104-2431
Phone number: 318-200-9156
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