Healthcare Provider Details

I. General information

NPI: 1104366509
Provider Name (Legal Business Name): ANASTASIA ARMSTRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 JEFFERSON DR
LAKE CHARLES LA
70605-5713
US

IV. Provider business mailing address

1698 CAMPFIRE RD
LAKE CHARLES LA
70611-6806
US

V. Phone/Fax

Practice location:
  • Phone: 337-431-7194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11141
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: