Healthcare Provider Details

I. General information

NPI: 1467481390
Provider Name (Legal Business Name): MARGARET MASCOLL LAC, CCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4012 AVENUE H
LAKE CHARLES LA
70615-5186
US

IV. Provider business mailing address

601 HOLMES ST
LAKE CHARLES LA
70615-3717
US

V. Phone/Fax

Practice location:
  • Phone: 337-491-2355
  • Fax: 337-491-2492
Mailing address:
  • Phone: 337-436-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number156
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: