Whiteside, Mia Deshawn

Whiteside, Mia Deshawn is an individual health care provider with primary practice located at 510 E Stoner Ave , Shreveport LA 71101-4243. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Whiteside, Mia Deshawn can be contacted via phone (318) 221-8411.

Contact Information

Primary practice address
510 E Stoner Ave Shreveport LA 71101-4243
Phone: (318) 221-8411
Fax: (915) 742-4890
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 62608 Texas

Profile Details

NPI number 1477925469
LBN Legal business name Whiteside, Mia Deshawn
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 29th, 2015
Last updated Sep 22nd, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477925469 NPPES
Texas Other 62608 ASSOCIATES OF SOCIAL WORK BOARD

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