Healthcare Provider Details

I. General information

NPI: 1700196912
Provider Name (Legal Business Name): NORTHSHORE PSYCHIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HIGHLAND PARK PLZ SUITE 107
COVINGTON LA
70433-7128
US

IV. Provider business mailing address

107 HIGHLAND PARK PLZ SUITE 107
COVINGTON LA
70433-7128
US

V. Phone/Fax

Practice location:
  • Phone: 985-875-7660
  • Fax: 985-875-7441
Mailing address:
  • Phone: 985-875-7660
  • Fax: 985-875-7441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10858R
License Number StateLA

VIII. Authorized Official

Name: MRS. LAURIE V WILLIAMS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 985-875-7660