Healthcare Provider Details

I. General information

NPI: 1629561618
Provider Name (Legal Business Name): UZIMA COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E BOSTON ST
COVINGTON LA
70433-2900
US

IV. Provider business mailing address

209 E SAINT MARY DR
COVINGTON LA
70433-7432
US

V. Phone/Fax

Practice location:
  • Phone: 985-960-7293
  • Fax:
Mailing address:
  • Phone: 985-960-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5143
License Number StateLA

VIII. Authorized Official

Name: EARNIESHA S LOTT
Title or Position: CEO
Credential: MED. LPC, RPT
Phone: 985-960-7392