MEDICARE: KIERRA POLLARD CIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CIT-5760	LA

General Provider Information

NPI Number	:	1134940745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERRA POLLARD CIT

Provider Business Mailing Address
First Line	:	9982 HIGHWAY 79
Second Line	:
City	:	BETHANY
State	:	LA
Zip	:	71007-8719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 KLUG PINES RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-3300
Country	:	US
Telephone Number	:	318-683-4622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “ KIERRA POLLARD CIT” Practice Location

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