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General NPI Number Information
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NPI Number | 1750015632
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Entity Type | Organization
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Legal Business Name | C. LOUISE LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 2445 REX RD APT DD2
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City | ELLENWOOD
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State | GA
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Zip | 30294-4422
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Country | US
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Telephone | 404-709-5148
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Fax |
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Provider Business Mailing Address
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Address Line | 5656 JONESBORO RD STE 111
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City | LAKE CITY
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State | GA
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Zip | 30260-3809
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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 | CEO
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Name | MS. CHANTAYE LOUISE MCLAUGHLIN
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Credential |
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Telephone | 404-709-5148
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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