Healthcare Provider Details

I. General information

NPI: 1710169503
Provider Name (Legal Business Name): RIVER CITY PROFESSIONAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 STUBBS AVE
MONROE LA
71201-5622
US

IV. Provider business mailing address

1210 STUBBS AVE
MONROE LA
71201-5622
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8782
  • Fax:
Mailing address:
  • Phone: 318-325-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH LYNN DOUBLIN
Title or Position: ADMINISTRATOR
Credential: LCSW
Phone: 318-325-8748