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General NPI Number Information
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NPI Number | 1043629165
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Entity Type | Organization
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Legal Business Name | DANA JUDICE LLC
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 411 WEEKS ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4551
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Country | US
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Telephone | 337-369-3000
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Fax | 337-369-3001
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Provider Business Mailing Address
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Address Line | 411 WEEKS ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4551
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Country | US
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Telephone | 337-369-3000
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Fax | 337-369-3001
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Authorized Official
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Title or Position | OWNER/SOCIAL WORKER
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Name | MR. DANA JUDICE
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Credential | LCSW
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Telephone | 337-369-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8245
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License Number State | LA
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