Provider Demographics
NPI:1588324693
Name:REAL TALK THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:REAL TALK THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VESSEL-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-434-0017
Mailing Address - Street 1:3350 RIDGELAKE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3831
Mailing Address - Country:US
Mailing Address - Phone:504-434-0017
Mailing Address - Fax:
Practice Address - Street 1:3350 RIDGELAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3831
Practice Address - Country:US
Practice Address - Phone:504-434-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty