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1316458748
ELLIOT JXAVIER LEWIS
SHREVEPORT, LA
NPI
1316458748
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: LA 1438)
Enumeration Date
2017-10-12
Last Update Date
2017-10-12
Business Address
Mr. ELLIOT JXAVIER LEWIS RAC
2000 FAIRFIELD AVE
SHREVEPORT, LA 71104-2002
Phone number: 318-226-2890
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Mailing Address
Mr. ELLIOT JXAVIER LEWIS RAC
525 CROCKETT ST
SHREVEPORT, LA 71101-3601
Phone number: 318-226-2890
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