Healthcare Provider Details

I. General information

NPI: 1407357205
Provider Name (Legal Business Name): HEATHER ELAINE CHAFFOULD CIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 4TH AVE STE 200
LAKE CHARLES LA
70601-7834
US

IV. Provider business mailing address

2829 4TH AVE STE 200
LAKE CHARLES LA
70601-7834
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4064
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: