Healthcare Provider Details

I. General information

NPI: 1265399828
Provider Name (Legal Business Name): MS. LARONDA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 RIVER QUEEN DR
VIOLET LA
70092-3525
US

IV. Provider business mailing address

2305 RIVER QUEEN DR
VIOLET LA
70092-3525
US

V. Phone/Fax

Practice location:
  • Phone: 985-233-4035
  • Fax:
Mailing address:
  • Phone: 985-233-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: