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General NPI Number Information
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NPI Number | 1487385282
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Entity Type | Organization
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Legal Business Name | WONDERFUL WORKS
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 16120 HIGHWAY 10 STE B
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City | GREENSBURG
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State | LA
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Zip | 70441-3657
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Country | US
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Telephone | 225-936-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 530 SMALL RD
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City | GREENSBURG
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State | LA
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Zip | 70441-3675
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Country | US
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Telephone | 225-936-9248
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Fax | 225-308-2057
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Authorized Official
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Title or Position | MANAGER
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Name | DILDRED SMALL WOMACK
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Credential | LMFT, LPC-S, BC-TMH
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Telephone | 225-936-9248
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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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