Individual
CHETIA JOHNSON THIBODEAUX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Contact information
Practice address
1933 WILDLIFE DR, BATON ROUGE, LA 70816-7450
(225) 324-3536
Mailing address
PO BOX 40242, BATON ROUGE, LA 70835-0242
(225) 324-3536
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
2905
LA
101YP2500X
Professional Counselor
Primary
2905
LA
106H00000X
Marriage & Family Therapist
856
LA
Other
Enumeration date
09/22/2010
Last updated
09/22/2010
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