Healthcare Provider Details

I. General information

NPI: 1750556015
Provider Name (Legal Business Name): SAINT JAMES COMMUNITY FRESH START PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
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: 225-623-9751
  • Fax: 225-258-4109
Mailing address:
  • Phone: 225-623-9751
  • Fax: 225-258-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BERTHA MAE DAVIS-WILLIAMS
Title or Position: DIRECTOR/CEO
Credential: PH.D., LPC
Phone: 225-623-9751