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General NPI Number Information
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NPI Number | 1336494616
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Entity Type | Organization
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Legal Business Name | DELTA COMMUNITY ACTION ASSOCIATION INC
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 07/23/2012
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Provider Practice Location Address
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Address Line | 404 E CRAIG ST
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City | TALLULAH
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State | LA
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Zip | 71282-3718
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Country | US
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Telephone | 318-574-4164
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Fax | 318-574-4164
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Provider Business Mailing Address
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Address Line | 404 E CRAIG ST
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City | TALLULAH
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State | LA
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Zip | 71282-3718
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Country | US
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Telephone | 318-574-4164
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Fax | 318-574-4164
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CARL SMITH
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Credential |
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Telephone | 318-574-2130
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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 | 179A
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 179B
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License Number State | LA
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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 | 179
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License Number State | LA
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