Individual
CLARISSA DIONE PUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3600 JACKSON ST STE 119, ALEXANDRIA, LA 71303-3096
(318) 308-3058
Mailing address
4352 CARLYLE LOOP, ALEXANDRIA, LA 71302-2864
(318) 308-3058
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9857
OTHERS
LA
Enumeration date
03/15/2017
Last updated
03/12/2024
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