Healthcare Provider Details

I. General information

NPI: 1881449676
Provider Name (Legal Business Name): LA FAMILIA DE VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 CITRUS BLVD
HARAHAN LA
70123-5845
US

IV. Provider business mailing address

5817 CITRUS BLVD
HARAHAN LA
70123-5845
US

V. Phone/Fax

Practice location:
  • Phone: 504-333-2206
  • Fax: 504-389-1207
Mailing address:
  • Phone: 504-259-5407
  • Fax: 504-389-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHONELL L DILLON
Title or Position: CEO
Credential: LCSW-BACS
Phone: 504-259-5407