Healthcare Provider Details

I. General information

NPI: 1740091339
Provider Name (Legal Business Name): JACQUELL HONOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2968 GEN COLLINS AVE
NEW ORLEANS LA
70114-6859
US

IV. Provider business mailing address

2968 GEN COLLINS AVE
NEW ORLEANS LA
70114-6859
US

V. Phone/Fax

Practice location:
  • Phone: 504-766-7098
  • Fax:
Mailing address:
  • Phone: 504-766-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: