Healthcare Provider Details

I. General information

NPI: 1922543107
Provider Name (Legal Business Name): SOUTHERN COMMUNITY NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 CANAL ST SUITE 316
NEW ORLEANS LA
70119-5548
US

IV. Provider business mailing address

2714 CANAL ST SUITE 316
NEW ORLEANS LA
70119-5548
US

V. Phone/Fax

Practice location:
  • Phone: 504-913-9335
  • Fax: 985-785-7728
Mailing address:
  • Phone: 504-913-9335
  • Fax: 985-785-7728

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NAAMAN STEWART
Title or Position: PRESIDENT
Credential: LMSW
Phone: 504-913-0901