Individual provider · NPI-1

Derrick Lamar Addison Sr.

Counselor, Mental Health · Shreveport, LA

NPI number1093239352
StatusActive
Last updated in NPPESJul 28, 2017

Details

NPI
1093239352
Entity type
Individual (NPI-1)
Name
Derrick Lamar Addison Sr.
Sex
Male
Sole proprietor
No
Enumeration date
Jul 28, 2017
Last updated
Jul 28, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
101YM0800X Counselor, Mental Health–LAYes
101YM0800X Counselor, Mental Health––

Practice location

9467 Milbank Dr
Shreveport, LA 71115-3868

Phone 318-655-6318

Mailing address

1717 Marshall St
Shreveport, LA 71101-4139

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