Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 846 | LA |
NPI | 1104986363 |
---|---|
Provider Name | Theresa Ann Wozencraft |
First Address | Lafayette, LA 70503-6127 |
Second Address | Lafayette, LA 70508-4230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |