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General NPI Number Information
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NPI Number | 1487890448
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Entity Type | Individual
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Provider Name | DAVID PAUL WYMAN LAC
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Gender | Male
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 100 ASMA BLVD
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City | LAFAYETTE
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State | LA
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Zip | 70508-3858
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Country | US
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Telephone | 337-456-7880
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Fax |
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Provider Business Mailing Address
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Address Line | 211 WOODLAND CIR
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City | NEW IBERIA
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State | LA
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Zip | 70563-2912
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Country | US
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Telephone | 337-322-6899
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Fax |
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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 | 588
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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