Healthcare Provider Details

I. General information

NPI: 1093548539
Provider Name (Legal Business Name): TRANSFORMING LIVES SOCIAL EMOTIONAL WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7541 DOGWOOD DR
NEW ORLEANS LA
70126-2007
US

IV. Provider business mailing address

7541 DOGWOOD DR
NEW ORLEANS LA
70126-2007
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-1518
  • Fax:
Mailing address:
  • Phone: 504-264-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. SHONTELL MAGEE DOLLIOLE
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: PHD
Phone: 504-264-1518