Provider Demographics
NPI:1225572514
Name:PILLOWS, DEMETRIS
Entity Type:Individual
Prefix:
First Name:DEMETRIS
Middle Name:
Last Name:PILLOWS
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 1:2605 BETTY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5553
Mailing Address - Country:US
Mailing Address - Phone:318-216-3748
Mailing Address - Fax:318-216-3786
Practice Address - Street 1:404 HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-716-1369
Practice Address - Fax:318-675-0120
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator