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General NPI Number Information
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NPI Number | 1700341393
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Entity Type | Organization
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Legal Business Name | REWIRED, COUNSELING AND BRAINSPOTTING, LLC
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1250 SW RAILROAD AVE STE 170
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City | HAMMOND
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State | LA
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Zip | 70403-5011
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Country | US
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Telephone | 985-288-1315
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Fax |
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Provider Business Mailing Address
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Address Line | 47191 BENDER RD
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City | HAMMOND
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State | LA
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Zip | 70401-6829
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Country | US
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Telephone | 985-288-1315
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR/OWNER
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Name | EMILY R. MOISE-FONTENOT
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Credential | LPC-S
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Telephone | 985-288-1315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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