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General NPI Number Information
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NPI Number | 1528555018
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Entity Type | Organization
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Legal Business Name | FOREVER WELLNESS & RECOVERY LLC
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 910 PIERREMONT RD STE 311
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City | SHREVEPORT
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State | LA
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Zip | 71106-2058
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Country | US
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Telephone | 318-525-6099
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Fax |
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Provider Business Mailing Address
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Address Line | 910 PIERREMONT RD STE 300
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City | SHREVEPORT
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State | LA
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Zip | 71106-2056
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Country | US
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Telephone | 318-562-6616
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Fax | 318-562-6618
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KRISTI BIERBAUM
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Credential | LPC-S
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Telephone | 318-562-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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