Provider Demographics
NPI:1831842392
Name:DUFRENE, MARK P
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:DUFRENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-3643
Mailing Address - Country:US
Mailing Address - Phone:985-803-9123
Mailing Address - Fax:
Practice Address - Street 1:126 RUE COLETTE
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5628
Practice Address - Country:US
Practice Address - Phone:985-625-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor