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General NPI Number Information
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NPI Number | 1730547977
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Entity Type | Organization
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Legal Business Name | PARAGON WELLNESS, LLC
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 726 E RUTLAND ST
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City | COVINGTON
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State | LA
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Zip | 70433-3223
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Country | US
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Telephone | 985-789-9496
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MALLARD DR
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City | HAMMOND
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State | LA
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Zip | 70401-7522
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Country | US
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Telephone | 985-789-9496
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. WILLIAM KENNETH KNIGHT JR.
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Credential | LPC
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Telephone | 985-789-9496
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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 | LPC 5820
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License Number State | LA
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