Individual
THAWANDA R CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S BROAD ST, NEW ORLEANS, LA 70119-6447
(504) 301-3919
Mailing address
404 JEFFER DR, WESTWEGO, LA 70094-2160
(503) 273-3949
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/05/2018
Last updated
12/05/2018
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