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General NPI Number Information
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NPI Number | 1952471609
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Entity Type | Organization
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Legal Business Name | SHINING STAR PROFESSIONAL SERVICES INC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9050 YOUREE DRIVE #1004
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City | SHREVEPORT
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State | LA
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Zip | 71115
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Country | US
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Telephone | 318-795-8055
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Fax | 318-635-7100
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Provider Business Mailing Address
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Address Line | 9050 YOUREE DRIVE #1004
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City | SHREVEPORT
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State | LA
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Zip | 71115
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Country | US
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Telephone | 318-795-8055
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Fax | 318-635-7100
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Authorized Official
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Title or Position | OWNER
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Name | AKEE LJ JACKSON
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Credential | LCSW
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Telephone | 318-795-8055
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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 | 4322
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License Number State | LA
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