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Individual

SAMANTHA BORDELON GREMILLION

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1663 KEED AVE, BATON ROUGE, LA 70806-8138
(318) 359-4419
Mailing address
1663 KEED AVE, BATON ROUGE, LA 70806-8138

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
87-1687325
LLC
LA
Enumeration date
06/27/2022
Last updated
06/27/2022
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