Provider Demographics
NPI:1124747209
Name:VITALITY ADDICTION SOLUTIONS OF NEW IBERIA, LLC
Entity type:Organization
Organization Name:VITALITY ADDICTION SOLUTIONS OF NEW IBERIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-329-6783
Mailing Address - Street 1:PO BOX 82599
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-2599
Mailing Address - Country:US
Mailing Address - Phone:337-465-1195
Mailing Address - Fax:
Practice Address - Street 1:605 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4820
Practice Address - Country:US
Practice Address - Phone:337-465-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VITALITY ADDICTION SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty