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General NPI Number Information
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NPI Number | 1447004429
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Entity Type | Individual
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Provider Name | ALVIN SCOTT DUTRUCH LPC, NCC, MAC
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Gender |
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Dates
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Enumeration Date | 04/15/2024
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Last Update Date | 11/10/2024
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Provider Practice Location Address
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Address Line | 20015 CAMPGROUND RD APT 4
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City | COVINGTON
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State | LA
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Zip | 70435-3403
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Country | US
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Telephone | 985-260-2874
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Fax | 985-520-2874
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Provider Business Mailing Address
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Address Line | 20015 CAMPGROUND RD APT 4
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City | COVINGTON
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State | LA
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Zip | 70435-3403
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Country | US
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Telephone | 985-260-2003
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Fax | 985-260-2004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MAC5688
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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 | LPC9822
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License Number State | LA
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