Healthcare Provider Details

I. General information

NPI: 1770637795
Provider Name (Legal Business Name): CHRISTINE FORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E 123RD ST
GALLIANO LA
70354-4223
US

IV. Provider business mailing address

180 OLD LA 1
LOCKPORT LA
70374
US

V. Phone/Fax

Practice location:
  • Phone: 985-632-2175
  • Fax: 985-632-8651
Mailing address:
  • Phone: 985-693-7983
  • Fax: 985-632-8651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number596
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: