Provider Demographics
NPI:1700258167
Name:RUFFINS, CLEASHA
Entity type:Individual
Prefix:
First Name:CLEASHA
Middle Name:
Last Name:RUFFINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5636 S LAKESHORE DR APT 733
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-4015
Mailing Address - Country:US
Mailing Address - Phone:318-286-0847
Mailing Address - Fax:
Practice Address - Street 1:5636 S LAKESHORE DR APT 733
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-4015
Practice Address - Country:US
Practice Address - Phone:318-286-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health