Individual
DYNASTY MARIA RUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11445 REIGER RD, BATON ROUGE, LA 70809-4556
(225) 932-9867
Mailing address
9222 REDWOOD LAKE BLVD, ZACHARY, LA 70791-8336
(225) 202-9025
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
PLM1552
LA
106S00000X
Behavior Technician
—
LA
Other
Enumeration date
08/16/2019
Last updated
07/09/2024
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