Healthcare Provider Details

I. General information

NPI: 1669992780
Provider Name (Legal Business Name): DDP OUTREACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12097 OLD HAMMOND HWY STE I2
BATON ROUGE LA
70816-8679
US

IV. Provider business mailing address

12097 OLD HAMMOND HWY STE I2
BATON ROUGE LA
70816-8679
US

V. Phone/Fax

Practice location:
  • Phone: 225-802-6914
  • Fax:
Mailing address:
  • Phone: 225-831-9249
  • Fax: 225-831-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JA'MAL TITUS
Title or Position: OWNER/CEO
Credential:
Phone: 225-802-6914