Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 7260 | LA |
N | 101YS0200X | School Counselor | LA |
NPI | 1063003135 |
---|---|
Provider Name | Dana Bourgeois |
First Address | Thibodaux, LA 70301 |
Second Address | Thibodaux, LA 70301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 01/02/2021 |