Healthcare Provider Details

I. General information

NPI: 1649633413
Provider Name (Legal Business Name): ADAM RIVAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N TONTI ST
NEW ORLEANS LA
70119-3549
US

IV. Provider business mailing address

1125 N TONTI ST
NEW ORLEANS LA
70119-3549
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9211
  • Fax:
Mailing address:
  • Phone: 504-821-9211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5278
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5278
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5278
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: