Healthcare Provider Details

I. General information

NPI: 1831860592
Provider Name (Legal Business Name): SOPHIA CECILE BOLOGNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date: 06/21/2026
Reactivation Date: 07/23/2026

III. Provider practice location address

46 HAROLEANS ST
NEW ORLEANS LA
70123-4906
US

IV. Provider business mailing address

10202 PERKINS ROWE STE E-160
BATON ROUGE LA
70810-2067
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-3010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC11342
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: