Individual
MR. ERIC THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
622 RIVERSIDE DR, MONROE, LA 71201-6211
(318) 398-0945
Mailing address
107 ASHFORD DR APT 511, WEST MONROE, LA 71291-7851
(318) 557-5953
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
7145
LA
Other
Enumeration date
06/09/2017
Last updated
06/10/2020
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