Healthcare Provider Details

I. General information

NPI: 1609290782
Provider Name (Legal Business Name): STACY ARCENEAUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
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

2829 4TH AVE SUITE 200
LAKE CHARLES LA
70601-7887
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 Number3048
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: