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General NPI Number Information
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NPI Number | 1275082851
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Entity Type | Organization
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Legal Business Name | NOLA INTERVENTION, LLC
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 4300 S I 10 SERVICE RD W 103L
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City | METAIRIE
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State | LA
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Zip | 70001-7405
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Country | US
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Telephone | 614-602-7614
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 S I 10 SERVICE RD W 103L
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City | METAIRIE
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State | LA
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Zip | 70001-7405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ADRIENNE DIXSON
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Credential | PH.D.
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Telephone | 614-602-7614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 10719742#2NJ62
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License Number State | LA
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