Healthcare Provider Details

I. General information

NPI: 1235575945
Provider Name (Legal Business Name): ARJ LA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 CANAL ST
NEW ORLEANS LA
70119-6037
US

IV. Provider business mailing address

223 W MOREHEAD ST
CHARLOTTE NC
28202-1521
US

V. Phone/Fax

Practice location:
  • Phone: 504-324-5648
  • Fax: 704-910-5607
Mailing address:
  • Phone: 504-324-5648
  • Fax: 704-910-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENDELL JASPER
Title or Position: CLINIC DIRECTOR
Credential: PH.D.
Phone: 504-324-5648