Healthcare Provider Details

I. General information

NPI: 1932316221
Provider Name (Legal Business Name): ST JAMES COMMUNITY FRESH START PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N EZIDORE ST
GRAMERCY LA
70052-0850
US

IV. Provider business mailing address

PO BOX 850
GRAMERCY LA
70052-0850
US

V. Phone/Fax

Practice location:
  • Phone: 225-258-4029
  • Fax: 225-258-4109
Mailing address:
  • Phone: 225-258-4029
  • Fax: 225-258-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: BERTHA MAE DAVIS WILLIAMS
Title or Position: DIRECTOR CEO
Credential: PHD NBCC
Phone: 225-623-9751