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General NPI Number Information
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NPI Number | 1881449676
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Entity Type | Organization
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Legal Business Name | LA FAMILIA DE VILLAGE
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 7809 AIRLINE DR STE 200A
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City | METAIRIE
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State | LA
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Zip | 70003-6440
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Country | US
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Telephone | 504-333-2206
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Fax | 504-389-6219
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Provider Business Mailing Address
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Address Line | 1411 S WILSON AVE
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City | METAIRIE
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State | LA
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Zip | 70003-6223
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Country | US
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Telephone | 504-259-5407
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Fax | 504-389-6219
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Authorized Official
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Title or Position | CEO
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Name | SHONELL L DILLON
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Credential | LCSW-BACS
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Telephone | 504-259-5407
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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