Individual
JACQUANA ALFRED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
241 W SALLIER ST, LAKE CHARLES, LA 70601-5892
(337) 602-6663
Mailing address
241 W SALLIER ST, LAKE CHARLES, LA 70601-5892
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/08/2016
Last updated
10/08/2016
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