Healthcare Provider Details

I. General information

NPI: 1134584154
Provider Name (Legal Business Name): RONALD DELAUNE LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S BROAD ST
NEW ORLEANS LA
70119-7410
US

IV. Provider business mailing address

3712 KIM ST
METAIRIE LA
70001-3955
US

V. Phone/Fax

Practice location:
  • Phone: 504-827-2928
  • Fax: 504-827-2926
Mailing address:
  • Phone: 504-495-1552
  • Fax: 504-827-2926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1524
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number1542
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: