Healthcare Provider Details

I. General information

NPI: 1427738442
Provider Name (Legal Business Name): AVERETTE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 RIDGEWAY DR STE 102
LAFAYETTE LA
70503-3402
US

IV. Provider business mailing address

141 RIDGEWAY DR STE 102
LAFAYETTE LA
70503-3402
US

V. Phone/Fax

Practice location:
  • Phone: 337-806-8783
  • Fax: 337-279-3626
Mailing address:
  • Phone: 337-806-8783
  • Fax: 337-279-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CEDRINA KNIGHT AVERETTE
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 337-806-8783