Provider Demographics
NPI:1487373973
Name:CUP WITH A TWIST OF COCOA
Entity type:Organization
Organization Name:CUP WITH A TWIST OF COCOA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYMILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-366-6118
Mailing Address - Street 1:1324 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-1814
Mailing Address - Country:US
Mailing Address - Phone:337-366-6118
Mailing Address - Fax:337-443-0456
Practice Address - Street 1:1324 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-1814
Practice Address - Country:US
Practice Address - Phone:337-366-6118
Practice Address - Fax:337-443-0456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUP WITH A TWIST OF COCOA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-26
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty