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General NPI Number Information
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NPI Number | 1578919684
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Entity Type | Individual
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Provider Name | DEMETRA K DANTZLER HCI, NHCE, M.S, B.S
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Gender | Female
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 11499 WELLINGTON LN
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City | HAMMOND
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State | LA
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Zip | 70403
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Country | US
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Telephone | 985-981-4274
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Fax |
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Provider Business Mailing Address
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Address Line | 11499 WELLINGTON LN
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City | HAMMOND
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State | LA
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Zip | 70403-8607
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Country | US
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Telephone | 985-981-4274
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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 | 174H00000X
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Taxonomy Name | Health Educator
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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 | 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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