Healthcare Provider Details

I. General information

NPI: 1730585589
Provider Name (Legal Business Name): NAKIA SHANA THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 08/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4813 BRAMBLE WAY
SHREVEPORT LA
71118-2806
US

IV. Provider business mailing address

4813 BRAMBLE WAY
SHREVEPORT LA
71118-2806
US

V. Phone/Fax

Practice location:
  • Phone: 318-207-0267
  • Fax: 844-871-2020
Mailing address:
  • Phone: 318-207-0267
  • Fax: 844-871-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9568
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberAN526185
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: