Individual
DEMETRIA WITHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 ABIGAYLE ROW, SCOTT, LA 70583-8909
(337) 313-4300
Mailing address
124 ABIGAYLE ROW, SCOTT, LA 70583-8909
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174910004
—
LA
Enumeration date
08/23/2018
Last updated
06/29/2020
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