Healthcare Provider Details

I. General information

NPI: 1215458930
Provider Name (Legal Business Name): YOLANDA HENSLEY DODSON B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT STREET BLDG. 4 SUITE 426
SHREVEPORT LA
71105
US

IV. Provider business mailing address

2924 KNIGHT ST STE 426
SHREVEPORT LA
71105-2414
US

V. Phone/Fax

Practice location:
  • Phone: 318-754-3560
  • Fax: 318-779-0439
Mailing address:
  • Phone: 318-754-3560
  • Fax: 318-779-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberAN438599
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: