Healthcare Provider Details

I. General information

NPI: 1518323674
Provider Name (Legal Business Name): STAGES OF CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 CANAL ST 307
NEW ORLEANS LA
70119-5548
US

IV. Provider business mailing address

10001 LAKE FOREST BLVD # 906
NEW ORLEANS LA
70127-6200
US

V. Phone/Fax

Practice location:
  • Phone: 504-641-0649
  • Fax:
Mailing address:
  • Phone: 504-338-3068
  • Fax: 504-827-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TEKANA GAINER
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, CSW
Phone: 504-338-3068