Individual
ROSE ANN FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC
Contact information
Practice address
5505 SHREVEPORT HWY, PINEVILLE, LA 71360-3533
(318) 730-3878
Mailing address
107 RUTH ST, PINEVILLE, LA 71360-6660
(318) 730-3878
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CIT-5306
LA
Other
Enumeration date
12/02/2022
Last updated
10/17/2023
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