Provider Demographics
NPI:1154821163
Name:GUIDRY, DEVONTA
Entity Type:Individual
Prefix:
First Name:DEVONTA
Middle Name:
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1574
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-1574
Mailing Address - Country:US
Mailing Address - Phone:225-394-7213
Mailing Address - Fax:
Practice Address - Street 1:705 PINE ST
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2829
Practice Address - Country:US
Practice Address - Phone:225-394-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator