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General NPI Number Information
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NPI Number | 1144695206
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Entity Type | Individual
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Provider Name | COURTNEY HAWKINS MALVEAUX M.A., LPC-S
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Gender | Female
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 4266 WEST MAIN ST. STE 100 ROOM 106
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City | GRAY
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State | LA
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Zip | 70359-6421
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Country | US
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Telephone | 504-446-6410
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CESARE DR
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City | THIBODAUX
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State | LA
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Zip | 70301-1102
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Country | US
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Telephone | 504-255-7115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6249
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6249
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License Number State | LA
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