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General NPI Number Information
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NPI Number | 1154458529
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Entity Type | Individual
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Provider Name | MICHELLE CLAIRE COSTA LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4113 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70065-2202
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Country | US
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Telephone | 504-464-1021
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Fax | 504-464-1022
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Provider Business Mailing Address
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Address Line | 5721 PARKAIRE DR
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City | METAIRIE
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State | LA
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Zip | 70003-2321
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Country | US
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Telephone | 504-220-2525
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Fax | 504-885-6974
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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 | 4469
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License Number State | LA
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