Healthcare Provider Details

I. General information

NPI: 1265050736
Provider Name (Legal Business Name): ELEANOR HEALTH PROFESSIONAL LA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 S COLLEGE RD STE 204A
LAFAYETTE LA
70503-3062
US

IV. Provider business mailing address

PO BOX 386
PORTSMOUTH NH
03802-0386
US

V. Phone/Fax

Practice location:
  • Phone: 504-226-8768
  • Fax:
Mailing address:
  • Phone: 866-853-6162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NZINGA AJABU HARRISON
Title or Position: CHIEF MEDICAL OFFICER & OWNER
Credential: MD
Phone: 781-230-6838