Provider Demographics
NPI:1306103981
Name:CENLA PROFESSIONAL COUNSELING
Entity type:Organization
Organization Name:CENLA PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LICENSED TITLE L
Authorized Official - Phone:318-787-6805
Mailing Address - Street 1:1412 PETERMAN DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301
Mailing Address - Country:US
Mailing Address - Phone:318-787-6805
Mailing Address - Fax:318-787-6818
Practice Address - Street 1:1412 PETERMAN DRIVE
Practice Address - Street 2:SUITE
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-787-6805
Practice Address - Fax:318-787-6818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4257101YP2500X
LA101YP2500X
LA9371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235925OtherCAQH