Healthcare Provider Details

I. General information

NPI: 1649453879
Provider Name (Legal Business Name): CENTER FOR PERSONAL DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LAMY LN
MONROE LA
71201-3737
US

IV. Provider business mailing address

PO BOX 4381
MONROE LA
71211-4381
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-0240
  • Fax: 318-329-0239
Mailing address:
  • Phone: 318-512-1257
  • Fax: 318-343-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number7268
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MISS LORIA S. PIERCE
Title or Position: PRESIDENT
Credential: LMFT
Phone: 318-512-1257