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General NPI Number Information
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NPI Number | 1356116594
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Entity Type | Organization
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Legal Business Name | HUMANITY2020 GROUP LLC
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 602 MAIN ST STE 113
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City | PINEVILLE
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State | LA
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Zip | 71360-6936
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Country | US
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Telephone | 318-413-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 201 CENTURY VILLAGE BLVD STE 256
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City | MONROE
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State | LA
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Zip | 71203-2008
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Country | US
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Telephone | 318-413-5995
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Fax |
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Authorized Official
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Title or Position | CEO/ADMIN
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Name | MAYQUIE JACKSON
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Credential |
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Telephone | 318-895-6106
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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 |
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License Number State |
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