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General NPI Number Information
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NPI Number | 1043718315
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Entity Type | Organization
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Legal Business Name | THE REFUGE 18-2 LLC
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 3525 HESSMER AVE
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City | METAIRIE
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State | LA
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Zip | 70002-6409
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Country | US
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Telephone | 318-548-4018
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Fax |
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Provider Business Mailing Address
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Address Line | 49 CARSON CT
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-2633
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Country | US
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Telephone | 318-548-4018
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHELLE DUGAS
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Credential |
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Telephone | 318-548-4018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4457
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 4457
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License Number State | LA
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