| Positive Change | |
|
351 W 79th St Shreveport LA 71106-4819 | |
| (318) 688-8190 | |
| Not Available |
| Full Name | Positive Change |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 351 W 79th St, Shreveport, Louisiana |
| Authorized Official Name and Position | Keesha Dinkins (BUSINESS MANAGER) |
| Authorized Official Contact | 3186888190 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Change 1100 W 70th St Apt 1401 Shreveport LA 71106-3562 Ph: (318) 572-7517 | Positive Change 351 W 79th St Shreveport LA 71106-4819 Ph: (318) 688-8190 |
| NPI Number | 1982079075 |
|---|---|
| Provider Enumeration Date | 12/01/2015 |
| Last Update Date | 12/01/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982079075 | NPI | - | NPPES |
| 2395157 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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