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1326712449
MIRANDA HENLEY THEODOS
JONESBORO, LA
NPI
1326712449
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Additional Taxonomies
101YM0800X Counselor, Mental Health
Enumeration Date
2021-08-03
Last Update Date
2021-08-16
Business Address
MIRANDA HENLEY THEODOS
525 ALEXANDER ST
JONESBORO, LA 71251-2001
Phone number: 318-259-4676
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Mailing Address
MIRANDA HENLEY THEODOS
1408 TECH FARM RD APT D15
RUSTON, LA 71270-5484
Phone number:
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