Organization Name: | SOUTHEAST LOUISIANA SOCIAL SERVICE SOLUTIONS, LLC |
NPI Number: | 1194130237 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAMELA DUPONT (OWNER) |
Mailing Address: | 4266 W Main St Ste 100 Gray |
State: | LA US |
Postal Code: | 703596421 |
Phone Number: | 9858567893 |
Fax Number: | 9853466944 |
NPI Enumeration Date: | 06/27/2014 |
NPI Last Update Date: | 06/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |