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General NPI Number Information
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NPI Number | 1619537651
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Entity Type | Organization
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Legal Business Name | THE THERAPEUTIC & RESTORATIVE VILLAGE
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 11/29/2019
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Provider Practice Location Address
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Address Line | 820 JORDAN ST STE 315C
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City | SHREVEPORT
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State | LA
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Zip | 71101-4512
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Country | US
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Telephone | 318-607-7839
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Fax |
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Provider Business Mailing Address
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Address Line | 9137 MANSFIELD RD APT 164
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City | SHREVEPORT
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State | LA
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Zip | 71118-3145
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Country | US
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Telephone | 318-607-7839
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FIONA FRANCIS
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Credential | LCSW
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Telephone | 318-607-7839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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