| Raw Ingenuity Llc | |
|
752 Tyson Dr Pineville LA 71360-5698 | |
| (318) 401-1945 | |
| Not Available |
| Full Name | Raw Ingenuity Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 752 Tyson Dr, Pineville, Louisiana |
| Authorized Official Name and Position | Quaneice Perry (OWNER) |
| Authorized Official Contact | 3184011945 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Raw Ingenuity Llc Po Box 3472 Pineville LA 71361-3472 Ph: () - | Raw Ingenuity Llc 752 Tyson Dr Pineville LA 71360-5698 Ph: (318) 401-1945 |
| NPI Number | 1154038602 |
|---|---|
| Provider Enumeration Date | 11/03/2022 |
| Last Update Date | 11/03/2022 |
| Certification Date | 11/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154038602 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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