Provider Demographics
NPI:1396500591
Name:MAXEY, COLLEEN
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MAXEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:CHARENTON
Mailing Address - State:LA
Mailing Address - Zip Code:70523-0126
Mailing Address - Country:US
Mailing Address - Phone:318-413-4927
Mailing Address - Fax:
Practice Address - Street 1:327 EAST MARTIN LUTHER KING ROAD
Practice Address - Street 2:
Practice Address - City:CHARENTON
Practice Address - State:LA
Practice Address - Zip Code:70523
Practice Address - Country:US
Practice Address - Phone:337-923-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty