Provider Demographics
NPI:1083981336
Name:DELAFOSSE, CELESTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:
Last Name:DELAFOSSE
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 1:407 VENUS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2523
Mailing Address - Country:US
Mailing Address - Phone:337-255-0172
Mailing Address - Fax:
Practice Address - Street 1:1001 W PINHOOK RD
Practice Address - Street 2:BLDG 3 SUITE 207
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2448
Practice Address - Country:US
Practice Address - Phone:337-255-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4214101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional