Individual
MARTHA LYNN FONTENOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
614 ESPLANADE ST, LAKE CHARLES, LA 70607-6308
(337) 478-1411
Mailing address
913 ARDMORE ST, LAKE CHARLES, LA 70605-5476
(337) 302-3157
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
808
LA
Other
Enumeration date
09/23/2008
Last updated
07/29/2011
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