Healthcare Provider Details

I. General information

NPI: 1164192928
Provider Name (Legal Business Name): JEANECA RAILEY CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 WHITNEY AVE
GRETNA LA
70056-5011
US

IV. Provider business mailing address

1400 SEMMES ST
NEW ORLEANS LA
70114-6193
US

V. Phone/Fax

Practice location:
  • Phone: 504-347-1120
  • Fax:
Mailing address:
  • Phone: 504-367-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: