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NPI Code Detail

MEDICARE: COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA

MEDICARE: COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902643455
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA
Provider Business Mailing Address
First Line : 2000 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2099
Country : US
Telephone Number : 318-222-8511
Fax Number : 318-425-9670
Provider Business Practice Location Address
First Line : 2000 FAIRFIELD AVE
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2002
Country : US
Telephone Number : 318-222-8511
Fax Number : 318-425-9670
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JANET MILLER
Credential :
Telephone Number : 318-222-8511
Provider Enumeration Date : 07/11/2024
Last Update Date : 05/11/2026

Similar Medicare Providers

1891152328 — COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA
Practice Location Address:
2000 FAIRFIELD AVE
SHREVEPORT, LA
71104-2002
Practice Phone: 318-222-8511
Practice Fax: 318-222-3273
1174047856 — MR. GREGORY H GENTRY LAC
Practice Location Address:
2000 FAIRFILED AVENUE
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1316457971 — CLAIRE CONERLY MADDEN CIT
Practice Location Address:
2000 FAIRFIELD AVE
SHREVEPORT, LA
71104-2002
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Practice Fax: 318-222-3273
1942710603 — RYAN LEE POMMIER RAC
Practice Location Address:
2000 FAIRFIELD AVE
SHREVEPORT, LA
71104-2002
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1285144873 — LUCILLE B HAYWARD LPC, LAC
Practice Location Address:
2000 FAIRFIELD AVE
SHREVEPORT, LA
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Practice Fax: 318-222-3273
1306356803 — MS. KIMBERLY SUE POWELL LPC
Practice Location Address:
2000 FAIRFIELD AVE
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Directions to “COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA ” Practice Location

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