Provider Demographics
NPI:1407213499
Name:PAYNE, EARNESTINE (BS MC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:EARNESTINE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:BS MC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 N SHERWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-5025
Mailing Address - Country:US
Mailing Address - Phone:225-281-1819
Mailing Address - Fax:
Practice Address - Street 1:1314 S MIKE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815
Practice Address - Country:US
Practice Address - Phone:225-281-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6780101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty