Healthcare Provider Details

I. General information

NPI: 1225505613
Provider Name (Legal Business Name): ERIC HENDRIX RSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 HAYES ST
RAYVILLE LA
71269-2531
US

IV. Provider business mailing address

2910 EVANGELINE ST
MONROE LA
71201-3724
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-5488
  • Fax:
Mailing address:
  • Phone: 318-388-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5616
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: