Organization Name: | COGNITIVE DEVELOPMENT CENTER |
NPI Number: | 1609247907 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ADRIAN FISHER (DIRECTOR) |
Mailing Address: | 1705 Felicia Ave Tallulah |
State: | LA US |
Postal Code: | 712828203 |
Phone Number: | 3185741232 |
Fax Number: | 3185748646 |
NPI Enumeration Date: | 10/13/2015 |
NPI Last Update Date: | 10/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2930 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |