Organization
DELTA GENETIC COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA S CLARK FNP (PRESIDENT)
(318) 278-1861
Entity
Organization
Contact information
Practice address
366 STOW CREEK RD, RUSTON, LA 71270-1643
(318) 278-1861
(318) 202-5193
Mailing address
PO BOX 632, RUSTON, LA 71273-0632
(318) 278-1861
(318) 202-5193
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2133187
—
LA
Enumeration date
11/02/2010
Last updated
03/08/2011
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