Healthcare Provider Details

I. General information

NPI: 1881954576
Provider Name (Legal Business Name): SESA SUBAN WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 CANAL ST 407
NEW ORLEANS LA
70119-5548
US

IV. Provider business mailing address

2714 CANAL ST 407
NEW ORLEANS LA
70119-5548
US

V. Phone/Fax

Practice location:
  • Phone: 504-827-2115
  • Fax: 504-827-2116
Mailing address:
  • Phone: 504-827-2115
  • Fax: 504-827-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9711
License Number StateLA

VIII. Authorized Official

Name: DR. SONIA L GILKEY
Title or Position: OWNER, EXECUTIVE DIRECTOR
Credential: PHD
Phone: 504-931-3945