Healthcare Provider Details

I. General information

NPI: 1407331259
Provider Name (Legal Business Name): JOURNEY TO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 READ BLVD
NEW ORLEANS LA
70127-3140
US

IV. Provider business mailing address

3443 ESPLANADE AVE APT 556
NEW ORLEANS LA
70119-2967
US

V. Phone/Fax

Practice location:
  • Phone: 504-241-0105
  • Fax: 888-977-1299
Mailing address:
  • Phone: 832-725-0581
  • Fax: 888-977-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA MARIE MILLS-MATTOX
Title or Position: OWNER
Credential: LCSW
Phone: 832-725-0581