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General NPI Number Information
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NPI Number | 1881117851
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Entity Type | Organization
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Legal Business Name | CATALYST FOR CHANGE
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 3305 METAIRIE RD
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City | METAIRIE
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State | LA
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Zip | 70001-5215
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Country | US
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Telephone | 504-251-0758
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Fax | 504-849-4040
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Provider Business Mailing Address
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Address Line | 3305 METAIRIE RD
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City | METAIRIE
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State | LA
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Zip | 70001-5215
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Country | US
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Telephone | 504-251-0758
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Fax | 504-849-4040
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Authorized Official
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Title or Position | OWNWE
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Name | ANGELA HENRY WILKLOW
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Credential | LCSW
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Telephone | 504-251-0758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5065
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License Number State | LA
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