Most Relevant Information
Provider Data
| NPI Number: | 1003451592 |
| Provider Name: | LAVETTE BLACK |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/08/2019 |
| Last Updated: | 11/08/2019 |
Provider Practice Location
6515 GREENWOOD RD
SHREVEPORT
LA
711198304
Practice Location Phone/Fax
| Phone: | 3182059968 |
| Fax: |
Provider Mailing Location
2800 YOUREE DR STE 120
SHREVEPORT
LA
711043667
Provider Mailing Phone/Fax
| Phone: | 3185626271 |
| Fax: | 3185626263 |