Provider Demographics
NPI:1699726299
Name:DEPARTMENT OF HEALTH & HOSPITALS
Entity type:Organization
Organization Name:DEPARTMENT OF HEALTH & HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:985-543-4071
Mailing Address - Street 1:202 E ROBERT ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-3350
Mailing Address - Country:US
Mailing Address - Phone:985-543-4070
Mailing Address - Fax:985-543-4073
Practice Address - Street 1:202 E ROBERT ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-3350
Practice Address - Country:US
Practice Address - Phone:985-543-4070
Practice Address - Fax:985-543-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty