Healthcare Provider Details

I. General information

NPI: 1326589433
Provider Name (Legal Business Name): CDC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 COLONIAL DR
BATON ROUGE LA
70806-6511
US

IV. Provider business mailing address

740 COLONIAL DR
BATON ROUGE LA
70806-6511
US

V. Phone/Fax

Practice location:
  • Phone: 225-216-9422
  • Fax: 225-216-1260
Mailing address:
  • Phone: 225-216-9422
  • Fax: 225-216-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number586
License Number StateLA

VIII. Authorized Official

Name: MS. CHERYL D CALKINS
Title or Position: DIRECTOR
Credential: M.A.
Phone: 225-216-9422