Individual
KONI BREAUX BRIDGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
108 STATE ST, LAKE CHARLES, LA 70605-5718
(337) 625-5664
Mailing address
PO BOX 1865, SULPHUR, LA 70664-1865
(337) 625-5664
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2739
LA
Other
Enumeration date
11/06/2007
Last updated
02/15/2019
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