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General NPI Number Information
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NPI Number | 1457604571
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Entity Type | Organization
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Legal Business Name | SPRINGS OF LIFE SERVICES, INCORPORATED
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Dates
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Enumeration Date | 10/26/2012
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Last Update Date | 10/26/2012
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Provider Practice Location Address
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Address Line | 2714 CANAL ST SUITE #304
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City | NEW ORLEANS
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State | LA
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Zip | 70119-5548
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Country | US
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Telephone | 504-495-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 215 DEVON RD
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City | LA PLACE
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State | LA
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Zip | 70068-5205
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Country | US
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Telephone | 504-495-0600
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Fax |
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Authorized Official
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Title or Position | CEO/DIRECTOR
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Name | MISS AUDREY PATRICIA BLACKWOOD
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Credential | LPC
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Telephone | 504-495-0600
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3753
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License Number State | LA
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