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General NPI Number Information
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NPI Number | 1114740354
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Entity Type | Organization
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Legal Business Name | DIAMOND SOLACE PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 401 EDWARDS ST STE 830
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City | SHREVEPORT
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State | LA
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Zip | 71101-5528
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Country | US
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Telephone | 225-351-1506
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Fax |
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Provider Business Mailing Address
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Address Line | 12044 AMSTERDAM AVE
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City | GEISMAR
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State | LA
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Zip | 70734-3359
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Country | US
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Telephone | 225-351-1506
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAYONTAE WILLIAMS
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Credential | PMHNP-BC
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Telephone | 225-351-1506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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