Individual
MRS. JOY CHARMAINE CLEMENT DERISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
1737 W SALE RD, SUITE 103, LAKE CHARLES, LA 70605-2579
(337) 480-1100
(337) 480-1174
Mailing address
1737 W SALE RD, SUITE 103, LAKE CHARLES, LA 70605-2579
(337) 480-1100
(337) 480-1174
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LA0048
LA
Other
Enumeration date
11/25/2008
Last updated
11/25/2008
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