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202 E Robert St Hammond LA 70401-3350 | |
| (985) 543-4070 | |
| (985) 543-4073 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 202 E Robert St, Hammond, Louisiana |
| Authorized Official Name and Position | Willie Wallace (CLINIC MANAGER) |
| Authorized Official Contact | 9855434071 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
202 E Robert St Hammond LA 70401-3350 Ph: (985) 543-4070 | 202 E Robert St Hammond LA 70401-3350 Ph: (985) 543-4070 |
| NPI Number | 1699726299 |
|---|---|
| Provider Enumeration Date | 05/16/2006 |
| Last Update Date | 02/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699726299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 023 (Louisiana) | Primary |
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