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General NPI Number Information
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NPI Number | 1629408406
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Entity Type | Organization
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Legal Business Name | FPHSA WASHINGTON ADDICTIVE DISORDERS CLINIC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 619 WILLIS AVE
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City | BOGALUSA
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State | LA
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Zip | 70427-3001
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Country | US
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Telephone | 985-732-6610
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Fax | 985-732-6626
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Provider Business Mailing Address
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Address Line | 619 WILLIS AVE
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City | BOGALUSA
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State | LA
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Zip | 70427-3001
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Country | US
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Telephone | 985-732-6610
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Fax | 985-732-6626
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. MELANIE WATKINS
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Credential |
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Telephone | 985-748-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 192
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License Number State | LA
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