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General NPI Number Information
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NPI Number | 1861925729
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Entity Type | Organization
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Legal Business Name | COGNITIVE DEVELOPMENT CENTER OF SEASIDE HEALTHCARE
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 3821 HIGHWAY 1
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City | RACELAND
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State | LA
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Zip | 70394-3146
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Country | US
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Telephone | 985-537-6776
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Fax | 985-537-6779
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Provider Business Mailing Address
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Address Line | 3821 HIGHWAY 1
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City | RACELAND
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State | LA
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Zip | 70394-3146
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Country | US
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Telephone | 985-537-6776
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Fax | 985-537-6779
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Authorized Official
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Title or Position | MHP
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Name | CLARISSA LAWSON
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Credential |
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Telephone | 985-537-6776
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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 | 13909
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License Number State | LA
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