Individual
GRACIA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12672 BROOKSHIRE AVE, BATON ROUGE, LA 70815-6804
(225) 963-6006
Mailing address
12672 BROOKSHIRE AVE, BATON ROUGE, LA 70815-6804
(225) 963-6006
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-60473
LA
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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