Healthcare Provider Details

I. General information

NPI: 1699472498
Provider Name (Legal Business Name): ALEXIS DAIGLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PAUL MAILLARD RD
LULING LA
70070-4349
US

IV. Provider business mailing address

5213 TRENTON ST
METAIRIE LA
70006-6441
US

V. Phone/Fax

Practice location:
  • Phone: 985-785-3656
  • Fax:
Mailing address:
  • Phone: 504-520-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16052
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: