Individual
DOMINIQUE TEASLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CIT
Contact information
Practice address
10627 US HWY 71, CHENEYVILLIE, LA 71325
(318) 279-2751
(318) 279-2755
Mailing address
PO BOX 407, CHENEYVILLE, LA 71325-0407
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4235
LA
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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