Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 12275 | LA |
NPI | 1003285610 |
---|---|
Provider Name | Mrs. Sara Doctor |
First Address | Covington, LA 70433-5903 |
Second Address | Covington, LA 70433-5903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2015 |
Last Update Date | 24/09/2015 |