Healthcare Provider Details

I. General information

NPI: 1194130237
Provider Name (Legal Business Name): SOUTHEAST LOUISIANA SOCIAL SERVICE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 W MAIN ST STE 100
GRAY LA
70359-6421
US

IV. Provider business mailing address

4266 W MAIN ST STE 100
GRAY LA
70359-6421
US

V. Phone/Fax

Practice location:
  • Phone: 985-856-7893
  • Fax: 985-346-6944
Mailing address:
  • Phone: 985-856-7893
  • Fax: 985-346-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PAMELA DUPONT
Title or Position: OWNER
Credential: NP
Phone: 985-856-7893