Healthcare Provider Details

I. General information

NPI: 1043771132
Provider Name (Legal Business Name): LA'FONDA NICOLE HEARD PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LA'FONDA NICOLE GREEN PSY. D

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 INTERLINE AVE STE 9A
BATON ROUGE LA
70809-1970
US

IV. Provider business mailing address

9151 INTERLINE AVE STE 9A
BATON ROUGE LA
70809-1970
US

V. Phone/Fax

Practice location:
  • Phone: 225-907-1698
  • Fax: 225-416-6164
Mailing address:
  • Phone: 225-907-1698
  • Fax: 225-416-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH322367
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: