Healthcare Provider Details

I. General information

NPI: 1770114217
Provider Name (Legal Business Name): CORE LOUISIANA COUNSELING & RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W JUDGE PEREZ DR
CHALMETTE LA
70043-4904
US

IV. Provider business mailing address

4534 OWENS BLVD
NEW ORLEANS LA
70122-1223
US

V. Phone/Fax

Practice location:
  • Phone: 504-656-4325
  • Fax:
Mailing address:
  • Phone: 504-234-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GOLDIN MURO
Title or Position: DIRECTOR
Credential: LAC
Phone: 504-656-4325