Healthcare Provider Details

I. General information

NPI: 1942310073
Provider Name (Legal Business Name): EDITH LOUISE DEVILBISS L.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 DULLES DR SUITE 1
LAFAYETTE LA
70506-3008
US

IV. Provider business mailing address

302 DULLES DR SUITE 1
LAFAYETTE LA
70506-3008
US

V. Phone/Fax

Practice location:
  • Phone: 337-262-5870
  • Fax: 337-262-1272
Mailing address:
  • Phone: 337-262-5870
  • Fax: 337-262-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLAC1106
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: