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General NPI Number Information
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NPI Number | 1124747209
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Entity Type | Organization
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Legal Business Name | VITALITY ADDICTION SOLUTIONS OF NEW IBERIA, LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 605 S LEWIS ST
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City | NEW IBERIA
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State | LA
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Zip | 70560-4820
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Country | US
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Telephone | 337-465-1195
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 82599
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City | LAFAYETTE
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State | LA
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Zip | 70598-2599
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Country | US
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Telephone | 337-465-1195
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LESLEY SHERMAN
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Credential | RN
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Telephone | 225-329-6783
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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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