Provider Demographics
NPI:1205363413
Name:BOURGEOIS, ELIZABETH D (DSW, LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:BOURGEOIS
Suffix:
Gender:F
Credentials:DSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 DESTRAHAN DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2951
Mailing Address - Country:US
Mailing Address - Phone:985-688-8606
Mailing Address - Fax:
Practice Address - Street 1:402 DESTRAHAN DR
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2951
Practice Address - Country:US
Practice Address - Phone:985-688-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker