Healthcare Provider Details

I. General information

NPI: 1215854617
Provider Name (Legal Business Name): FAITH MARIE SOUTHERLAND M.ED, PLPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 TULANE AVE
NEW ORLEANS LA
70119-7462
US

IV. Provider business mailing address

2601 TULANE AVE
NEW ORLEANS LA
70119-7462
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-2232
  • Fax:
Mailing address:
  • Phone: 504-821-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11229
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: