Healthcare Provider Details

I. General information

NPI: 1114452331
Provider Name (Legal Business Name): ELNORA VICKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ENTERPRISE DR STE D
HOUMA LA
70360-2535
US

IV. Provider business mailing address

2415 GOVERNMENT ST
BATON ROUGE LA
70806-5318
US

V. Phone/Fax

Practice location:
  • Phone: 985-303-0182
  • Fax: 985-303-0181
Mailing address:
  • Phone: 225-342-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10100
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10100
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: