Healthcare Provider Details

I. General information

NPI: 1841780590
Provider Name (Legal Business Name): PRESERVING HUMAN DIGNITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 20TH ST STE A101
KENNER LA
70062-4406
US

IV. Provider business mailing address

2002 20TH ST STE A101
KENNER LA
70062-4406
US

V. Phone/Fax

Practice location:
  • Phone: 504-450-1722
  • Fax:
Mailing address:
  • Phone: 504-450-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DIANE BREAUX JOHNSON
Title or Position: OWNER
Credential: MSW
Phone: 504-450-1722