Healthcare Provider Details

I. General information

NPI: 1013442433
Provider Name (Legal Business Name): DARLENE TERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LEMAIRE ST
NEW IBERIA LA
70560-4811
US

IV. Provider business mailing address

14 SHADOW BND
NEW IBERIA LA
70563-1757
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-2343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7279
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC7279
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: