Healthcare Provider Details

I. General information

NPI: 1124520309
Provider Name (Legal Business Name): CEDRINA KNIGHT AVERETTE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 KALISTE SALOOM RD BLDG 1
LAFAYETTE LA
70508-7449
US

IV. Provider business mailing address

3312 KALISTE SALOOM RD BLDG 1
LAFAYETTE LA
70508-7449
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0727
  • Fax: 337-534-0737
Mailing address:
  • Phone: 337-534-0727
  • Fax: 337-534-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1397
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: