Healthcare Provider Details

I. General information

NPI: 1700724093
Provider Name (Legal Business Name): EAGLES WINGS RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 COLE AVE STE 6
MONROE LA
71203-3814
US

IV. Provider business mailing address

208 COLE AVE STE 6
MONROE LA
71203-3814
US

V. Phone/Fax

Practice location:
  • Phone: 318-450-7649
  • Fax: 866-282-5030
Mailing address:
  • Phone: 318-450-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMAL GIPSON
Title or Position: OWNER/ CEO
Credential: LPC LAC CCS AADC
Phone: 318-450-7649