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General NPI Number Information
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NPI Number | 1285219949
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Entity Type | Organization
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Legal Business Name | B3 COMMUNITY ALLIANCE
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 6027 CANDICE LN
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City | LAKE CHARLES
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State | LA
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Zip | 70615-4773
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Country | US
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Telephone | 337-520-0057
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Fax |
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Provider Business Mailing Address
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Address Line | 6027 CANDICE LN
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City | LAKE CHARLES
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State | LA
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Zip | 70615-4773
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Country | US
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Telephone | 337-520-0057
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | DR. THERESA MARIE HARDY
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Credential | PHD, LAC, AADC
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Telephone | 337-249-0536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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