=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063675585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A PLUS EVALUATIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 CALCASIEU LOOP
-----------------------------------------------------
City | LEESVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71446-7118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-353-7694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 CALCASIEU LOOP
-----------------------------------------------------
City | LEESVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71446-7118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-353-7694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER/CEO
-----------------------------------------------------
Name | MS. DOLORES ERIKA CANCINO
-----------------------------------------------------
Credential | LCSW-BACS, C-ASWCM
-----------------------------------------------------
Telephone | 337-353-7694
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------