Healthcare Provider Details

I. General information

NPI: 1861503922
Provider Name (Legal Business Name): THERAPEUTIC CONNECTIONS COUNSELING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 LINDALE AVE STE E
BATON ROUGE LA
70815-4179
US

IV. Provider business mailing address

9425 LINDALE AVE STE E
BATON ROUGE LA
70815-4179
US

V. Phone/Fax

Practice location:
  • Phone: 225-928-3630
  • Fax: 225-928-3631
Mailing address:
  • Phone: 225-928-3630
  • Fax: 225-928-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4724
License Number StateLA

VIII. Authorized Official

Name: MS. GWENDOLYN STEWART BRITTON
Title or Position: OWNER/SOCIAL WORKER
Credential: LCSW
Phone: 225-928-3630