Most Relevant Information
Provider Data
| NPI Number: | 1003662883 |
| Provider Name: | DUBACHANETTE CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 385H00000X |
| Specialty: | Respite Care |
| License Number: | 770641488 |
Most Important Dates
| Enumeration Date: | 04/24/2024 |
| Last Updated: | 04/24/2024 |
Provider Practice Location
402 E CRAIG ST
TALLULAH
LA
712823718
Practice Location Phone/Fax
| Phone: | 3185749009 |
| Fax: |
Provider Mailing Location
402 E CRAIG ST
TALLULAH
LA
712823718
Provider Mailing Phone/Fax
| Phone: | 3185749009 |
| Fax: |