Individual provider · NPI-1

Innis Addison

Case Manager/Care Coordinator · Shreveport, LA

NPI number1477093060
StatusActive
Last updated in NPPESJun 12, 2019

Details

NPI
1477093060
Entity type
Individual (NPI-1)
Name
Innis Addison
Sex
Male
Sole proprietor
No
Enumeration date
Mar 1, 2017
Last updated
Jun 12, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171M00000X Case Manager/Care Coordinator––Yes
101YM0800X Counselor, Mental Health––

Other names

  • Innis Addison (Professional Name)

Practice location

200 N Thomas Dr
Suite 100
Shreveport, LA 71107-6503

Phone 318-424-8345

Mailing address

7607 Fern Ave Ste 902
Shreveport, LA 71105-5745

Phone 318-524-9954

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