Healthcare Provider Details

I. General information

NPI: 1336764893
Provider Name (Legal Business Name): ANNIE ROONEY MA, MS, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CHRISTIAN LN
SLIDELL LA
70458-1350
US

IV. Provider business mailing address

115 CHRISTIAN LN
SLIDELL LA
70458-1350
US

V. Phone/Fax

Practice location:
  • Phone: 985-690-6622
  • Fax: 985-690-6662
Mailing address:
  • Phone: 985-690-6622
  • Fax: 985-690-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLC8203
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number8203
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: