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1275039588
AMANDA EVETTE VITAL
LAKE CHARLES, LA
NPI
1275039588
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Former Name
AMANDA EVETTE WILSON
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2018-04-04
Last Update Date
2018-04-04
Business Address
AMANDA EVETTE VITAL BGS, M.A.T., Ed.S.
1409 KIRKMAN ST
LAKE CHARLES, LA 70601-5344
Phone number: 337-419-3586
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Mailing Address
AMANDA EVETTE VITAL BGS, M.A.T., Ed.S.
1409 KIRKMAN ST
LAKE CHARLES, LA 70601-5344
Phone number: 337-419-3586
Copy
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