Provider Demographics
NPI:1003376427
Name:DRUMGOOLE, KADARIO DERELL
Entity Type:Individual
Prefix:
First Name:KADARIO
Middle Name:DERELL
Last Name:DRUMGOOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3815
Mailing Address - Country:US
Mailing Address - Phone:318-861-8938
Mailing Address - Fax:
Practice Address - Street 1:3084 WESTFORK DR STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2254
Practice Address - Country:US
Practice Address - Phone:225-296-6083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical