Provider Demographics
NPI:1962156265
Name:BUGGAGE, CIERA MARIE
Entity type:Individual
Prefix:
First Name:CIERA
Middle Name:MARIE
Last Name:BUGGAGE
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 1:2590 HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5843
Mailing Address - Country:US
Mailing Address - Phone:225-803-1045
Mailing Address - Fax:
Practice Address - Street 1:2590 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5843
Practice Address - Country:US
Practice Address - Phone:985-313-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15295104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker