Individual
MS. LILLIAN GRACE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17534 OLD JEFFERSON HWY STE D1, PRAIRIEVILLE, LA 70769-3978
(985) 500-3130
Mailing address
996 ROYAL MARCO WAY, MARCO ISLAND, FL 34145-1829
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
012370240
LA
Other
Enumeration date
02/26/2024
Last updated
02/26/2024
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