Healthcare Provider Details

I. General information

NPI: 1699361980
Provider Name (Legal Business Name): SINCLAIR FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E CHARLES ST STE B
HAMMOND LA
70401-3306
US

IV. Provider business mailing address

206 E CHARLES ST STE B
HAMMOND LA
70401-3306
US

V. Phone/Fax

Practice location:
  • Phone: 985-956-7098
  • Fax:
Mailing address:
  • Phone: 985-956-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS STUART CARPENTER
Title or Position: DIRECTOR
Credential: LPC
Phone: 601-212-3782