Individual
LATOYA JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4396 GORDON WOODS DR, LAKE CHARLES, LA 70615-2997
(337) 215-0576
Mailing address
4396 GORDON WOODS DR, LAKE CHARLES, LA 70615-2997
(337) 215-0576
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/30/2017
Last updated
07/21/2022
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