DWAYNE JETER

SHREVEPORT, LA
NPI1487100194
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy171M00000X Case Manager/Care Coordinator
Additional Taxonomies101YM0800X Counselor, Mental Health
Enumeration Date2016-09-01
Last Update Date2018-12-05
Business Address
DWAYNE JETER
7505 PINES RD STE 1200I
SHREVEPORT, LA 71129-3900
Phone number: 318-716-1707
Mailing Address
DWAYNE JETER
PO BOX 104
ELYSIAN FIELDS, TX 75642-0104
Phone number: 903-503-3111
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