Individual
AMY NICOLE DYSART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
908 LOUISA AVE, RAYNE, LA 70578-7230
(225) 270-0100
Mailing address
908 LOUISA AVE, RAYNE, LA 70578-7230
(225) 270-0100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
9020
LA
Other
Enumeration date
06/10/2011
Last updated
12/06/2011
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