Provider Demographics
NPI:1699955815
Name:COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA
Entity type:Organization
Organization Name:COUNCIL ON ALCOHOLISM AND DRUG ABUSE OF NORTHWEST LOUISIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-8511
Mailing Address - Street 1:2000 FAIRFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104
Mailing Address - Country:US
Mailing Address - Phone:318-222-8511
Mailing Address - Fax:318-212-5565
Practice Address - Street 1:2000 FAIRFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-222-8511
Practice Address - Fax:318-212-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QR0405X, 324500000X
LA238324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1891152328OtherCLINIC NPI
LA1902643455OtherCLINIC NPI
LA3571471Medicaid
LA3571455Medicaid