Provider Demographics
NPI:1083228647
Name:ARDOIN, KACEY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:ELIZABETH
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10202 PERKINS ROWE APT 3022
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-8203
Mailing Address - Country:US
Mailing Address - Phone:404-702-3616
Mailing Address - Fax:
Practice Address - Street 1:10202 PERKINS ROWE APT 3022
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-8203
Practice Address - Country:US
Practice Address - Phone:404-702-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13983104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker