Healthcare Provider Details
I. General information
NPI: 1841444890
Provider Name (Legal Business Name): TOWNSEND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2600 JOHNSTON ST SUITE 110
LAFAYETTE LA
70503-3269
US
IV. Provider business mailing address
36132 EMERALD COAST PKWY
DESTIN FL
32541-5776
US
V. Phone/Fax
- Phone: 337-266-5155
- Fax: 337-266-5157
- Phone: 850-424-3914
- Fax: 850-424-3931
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 388 |
| License Number State | LA |
VIII. Authorized Official
Name: MR.
MICHAEL
HANDLEY
Title or Position: CEO
Credential:
Phone: 850-424-3914