Healthcare Provider Details

I. General information

NPI: 1639851272
Provider Name (Legal Business Name): ADRIANA GABRIELLE ASCENCIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADRIANA GABRIELLE SPURLOCK LCSW

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2223 OLD MINDEN RD STE A1
BOSSIER CITY LA
71112-2303
US

IV. Provider business mailing address

2223 OLD MINDEN RD STE A1
BOSSIER CITY LA
71112-2303
US

V. Phone/Fax

Practice location:
  • Phone: 318-726-2063
  • Fax: 318-333-1647
Mailing address:
  • Phone: 318-726-2063
  • Fax: 318-333-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number14901
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: