Healthcare Provider Details

I. General information

NPI: 1871060327
Provider Name (Legal Business Name): JOVAN DARBONNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S MAIN ST STE A
OPELOUSAS LA
70570-6133
US

IV. Provider business mailing address

115 S MAIN ST STE A
OPELOUSAS LA
70570-6133
US

V. Phone/Fax

Practice location:
  • Phone: 225-938-1360
  • Fax: 337-407-5104
Mailing address:
  • Phone: 225-938-1360
  • Fax: 337-407-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2203783831
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: