Individual
DOMINIQUE NICOLE DEBETAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
10431 SIEGEN LN STE 103, BATON ROUGE, LA 70810-4984
(225) 777-6824
Mailing address
24848 HERITAGE DR, DENHAM SPRINGS, LA 70726-6701
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14411
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255681128
—
LA
Enumeration date
06/12/2017
Last updated
02/01/2024
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