Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | LA |
NPI | 1003369885 |
---|---|
Provider Name | Courtney E Roquemore |
First Address | Robeline, LA 71469-4302 |
Second Address | Robeline, LA 71469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110648162 | (05) | LA |
929047191 | (05) | LA |