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Individual

CENTRELL SELF

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1417 W MORRIS AVE STE E, HAMMOND, LA 70403-3854
(985) 542-9949
Mailing address
90 HIGHWAY 1045, AMITE, LA 70422-7264

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
14439
LA

Other

Enumeration date
04/11/2017
Last updated
05/16/2019
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