Individual
DOMETRIA TINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 RICHARD ST, BREAUX BRIDGE, LA 70517-6039
(337) 319-4376
Mailing address
400 RICHARD ST, BREAUX BRIDGE, LA 70517-6039
(337) 319-4376
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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