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General NPI Number Information
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NPI Number | 1366801730
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Entity Type | Organization
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Legal Business Name | PROTECTIVE FACTORS, LLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 806 N 31ST ST SUITE B
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City | MONROE
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State | LA
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Zip | 71201-3900
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Country | US
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Telephone | 318-737-7794
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Fax | 318-605-4800
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Provider Business Mailing Address
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Address Line | 806 N 31ST ST SUITE B
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City | MONROE
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State | LA
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Zip | 71201-3900
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Country | US
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Telephone | 318-737-7794
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Fax | 318-605-4800
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VICTORIA PLEASANT-WALLACE
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Credential | LCSW
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Telephone | 318-450-2606
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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 |
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License Number State |
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