Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003277849 |
---|---|
Provider Name | Shannon Lewis |
First Address | New Orleans, LA 70115-5345 |
Second Address | New Orleans, LA 70115-5345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2016 |
Last Update Date | 07/03/2016 |