Healthcare Provider Details

I. General information

NPI: 1922436120
Provider Name (Legal Business Name): DIANNA FLOWERS FRUGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 FITZENREITER RD SBHC
LAKE CHARLES LA
70601-1139
US

IV. Provider business mailing address

1216 TEXAS ST
SULPHUR LA
70663-3623
US

V. Phone/Fax

Practice location:
  • Phone: 337-217-4890
  • Fax: 337-491-7132
Mailing address:
  • Phone: 337-625-8975
  • Fax: 337-491-7132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4506
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: