Healthcare Provider Details

I. General information

NPI: 1366474488
Provider Name (Legal Business Name): SHERYL JOHNSON MEEK LAC, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 4TH AVE SUITE 200
LAKE CHARLES LA
70601-7887
US

IV. Provider business mailing address

3145 CHARLOTTE AVE
WESTLAKE LA
70669-6407
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-8281
  • Fax: 337-433-7938
Mailing address:
  • Phone: 337-764-1627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1005
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: