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General NPI Number Information
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NPI Number | 1831976638
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA DEPENDENCY AND MENTAL HEALTH, LLC.
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 44 VERSAILLES BOULEVARD
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City | ALEXANDRIA
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State | LA
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Zip | 71303
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Country | US
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Telephone | 318-792-7575
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Fax | 318-225-4965
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Provider Business Mailing Address
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Address Line | 3009 LEGACY LOOP
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City | PINEVILLE
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State | LA
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Zip | 71360-4661
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Country | US
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Telephone | 318-632-7878
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Fax | 318-643-4484
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL LEE HALE
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Credential | PMHNP-BC, FNP-C
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Telephone | 318-632-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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