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General NPI Number Information
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NPI Number | 1740442169
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Entity Type | Organization
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Legal Business Name | MONROE ADDICTIVE DISORDERS CLINIC
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Dates
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Enumeration Date | 06/26/2008
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 3200 CONCORDIA AVE
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City | MONROE
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State | LA
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Zip | 71201-5113
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Country | US
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Telephone | 318-362-5188
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 CONCORDIA AVE
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City | MONROE
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State | LA
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Zip | 71201-5113
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC SUPERVISOR
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Name | LUCY LEWIS
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Credential |
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Telephone | 318-362-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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