Healthcare Provider Details

I. General information

NPI: 1922461904
Provider Name (Legal Business Name): AVANDA CRAFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N TONTI ST
NEW ORLEANS LA
70119-3549
US

IV. Provider business mailing address

3821 BURNTWOOD DR
HARVEY LA
70058-1612
US

V. Phone/Fax

Practice location:
  • Phone: 504-821-9211
  • Fax:
Mailing address:
  • Phone: 504-777-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number12225
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12225
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: