Individual
DEMETRIUS CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6044 INGRAM DR, BATON ROUGE, LA 70812-2327
(225) 315-2104
Mailing address
6044 INGRAM DR, BATON ROUGE, LA 70812-2327
(225) 315-2104
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/10/2017
Last updated
07/21/2022
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