| |
3030 Jackson St Alexandria LA 71301-4743 | |
(318) 625-7111 | |
(318) 625-7111 |
Full Name | |
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Speciality | Counselor - Addiction (substance Use Disorder) |
Location | 3030 Jackson St, Alexandria, Louisiana |
Authorized Official Name and Position | Benjamin K Cooper (MANAGER) |
Authorized Official Contact | 3184460231 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 13566 Alexandria LA 71315-3566 Ph: (318) 446-0231 | 3030 Jackson St Alexandria LA 71301-4743 Ph: (318) 625-7111 |
NPI Number | 1134628654 |
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Provider Enumeration Date | 02/10/2018 |
Last Update Date | 02/10/2018 |
Identifier | Type | State | Issuer |
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1134628654 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
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