Healthcare Provider Details

I. General information

NPI: 1730420779
Provider Name (Legal Business Name): JAMES EDWARD DANCE III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ROUGEAU LN
LECOMPTE LA
71346-9506
US

IV. Provider business mailing address

309 LAKERIDGE TRL
PINEVILLE LA
71360-4787
US

V. Phone/Fax

Practice location:
  • Phone: 318-776-5077
  • Fax:
Mailing address:
  • Phone: 318-243-2539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4290
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4290
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: