Healthcare Provider Details

I. General information

NPI: 1508312513
Provider Name (Legal Business Name): NOUVELLE VIE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 CHERRY ST
THIBODAUX LA
70301-2204
US

IV. Provider business mailing address

504 CHERRY ST
THIBODAUX LA
70301-2204
US

V. Phone/Fax

Practice location:
  • Phone: 985-859-7097
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4385
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number4385
License Number StateLA

VIII. Authorized Official

Name: ADRIENNE M NAQUIN-BOLTON
Title or Position: OWNER
Credential: LPC-S, NCC
Phone: 985-859-7097