Healthcare Provider Details

I. General information

NPI: 1972421980
Provider Name (Legal Business Name): MARLI DOLL FREAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 S JEFFERSON AVE STE D
COVINGTON LA
70433-3169
US

IV. Provider business mailing address

24 SYDNEY CT
COVINGTON LA
70433-4755
US

V. Phone/Fax

Practice location:
  • Phone: 985-807-5131
  • Fax:
Mailing address:
  • Phone: 985-807-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9852
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: