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1225346836
EDWIN D MIRADOR
SHREVEPORT, LA
NPI
1225346836
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: LA 1184)
Enumeration Date
2010-09-16
Last Update Date
2010-09-16
Business Address
Mr. EDWIN D MIRADOR RAC
510 E STONER AVE
SHREVEPORT, LA 71101-4243
Phone number: 318-863-7441
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Mailing Address
Mr. EDWIN D MIRADOR RAC
510 E STONER AVE
SHREVEPORT, LA 71101-4243
Phone number: 318-863-7441
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