Individual
DENISE DETIVEAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
157 TWIN OAKS DR, RACELAND, LA 70394-2761
(985) 209-5070
Mailing address
157 TWIN OAKS DR, RACELAND, LA 70394-2761
(985) 209-5070
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
08/28/2020
Last updated
09/25/2020
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