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General NPI Number Information
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NPI Number | 1427173954
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Entity Type | Organization
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Legal Business Name | NORTHSHORE COUNSELING AND WELLNESS LLC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 671 RIVER HIGHLANDS BLVD STE 8
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City | COVINGTON
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State | LA
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Zip | 70433-8987
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Country | US
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Telephone | 985-624-2942
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Fax | 985-231-1373
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Provider Business Mailing Address
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Address Line | 234 LAMARQUE ST
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City | MANDEVILLE
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State | LA
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Zip | 70448-5931
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Country | US
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Telephone | 985-624-2942
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Fax | 985-231-1373
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDRE SAGRERA JUDICE
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Credential | PHD
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Telephone | 985-624-2942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 529
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2479
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License Number State | LA
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