Healthcare Provider Details

I. General information

NPI: 1164144507
Provider Name (Legal Business Name): AMNA HUSAIN SPEARS LCSW-BACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 CAREY ST
SLIDELL LA
70458-3627
US

IV. Provider business mailing address

2331 CAREY ST
SLIDELL LA
70458-3627
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-6406
  • Fax: 985-646-6460
Mailing address:
  • Phone: 985-646-6406
  • Fax: 985-646-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9450
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: