Healthcare Provider Details

I. General information

NPI: 1891608345
Provider Name (Legal Business Name): CONCRETE ROSE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 PAUGER ST
NEW ORLEANS LA
70122-6820
US

IV. Provider business mailing address

3761 PAUGER ST STE 505
NEW ORLEANS LA
70122-6820
US

V. Phone/Fax

Practice location:
  • Phone: 504-415-8838
  • Fax:
Mailing address:
  • Phone: 504-415-8838
  • Fax:

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

VIII. Authorized Official

Name: MISS GERQUEL MONCHEL BOWMAN
Title or Position: CEO
Credential: LPC
Phone: 504-415-8838