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1548760952
LATRISHIA GANT JACKSON
SHREVEPORT, LA
NPI
1548760952
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2018-02-13
Last Update Date
2018-02-13
Business Address
LATRISHIA GANT JACKSON
543 STONER AVE
SHREVEPORT, LA 71101-4122
Phone number: 318-673-9901
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Mailing Address
LATRISHIA GANT JACKSON
543 STONER AVE
SHREVEPORT, LA 71101-4122
Phone number: 318-673-9901
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