Healthcare Provider Details

I. General information

NPI: 1912447095
Provider Name (Legal Business Name): CIRCLE OF FRIENDS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PIERRE AVE SUITE A
SHREVEPORT LA
71103-2725
US

IV. Provider business mailing address

700 PIERRE AVE SUITE A
SHREVEPORT LA
71103-2725
US

V. Phone/Fax

Practice location:
  • Phone: 318-532-9214
  • Fax: 318-603-6622
Mailing address:
  • Phone: 318-532-9214
  • Fax: 318-603-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. DARNELL LINNEAR
Title or Position: DIRECTOR
Credential: MBA
Phone: 318-532-9214