Healthcare Provider Details

I. General information

NPI: 1619896446
Provider Name (Legal Business Name): CARLA PENNINGTON GUILLORY PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 JACKSON ST
ALEXANDRIA LA
71301-6930
US

IV. Provider business mailing address

4701 SAMPLE PL
ALEXANDRIA LA
71303-3781
US

V. Phone/Fax

Practice location:
  • Phone: 318-787-6805
  • Fax:
Mailing address:
  • Phone: 318-792-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC11317
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: