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General NPI Number Information
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NPI Number | 1558679589
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Entity Type | Organization
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Legal Business Name | COUVILLION WELLNESS, LLC
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 3004 JACKSON ST SUITE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-4745
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Country | US
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Telephone | 318-787-5952
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Fax | 318-787-5962
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Provider Business Mailing Address
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Address Line | 3004 JACKSON ST SUITE A
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City | ALEXANDRIA
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State | LA
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Zip | 71301-4745
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Country | US
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Telephone | 318-787-5952
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Fax | 318-787-5962
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | GINGER COUVILLION
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Credential |
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Telephone | 318-787-5952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 5969
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 04977
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License Number State | LA
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