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General NPI Number Information
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NPI Number | 1063611838
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Entity Type | Individual
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Provider Name | DELLA EDWARDS WILLS LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 4615 MONKHOUSE DRIVE STE A-2-B
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City | SHREVEPORT
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State | LA
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Zip | 71109
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Country | US
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Telephone | 318-773-4505
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Fax | 318-635-9348
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Provider Business Mailing Address
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Address Line | PO BOX 29205
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City | SHREVEPORT
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State | LA
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Zip | 71149
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Country | US
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Telephone | 318-635-9348
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Fax | 318-635-9348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2512
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License Number State | LA
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