Provider Demographics
NPI:1225359136
Name:MOORMAN, JUANITA GOLEMON (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:GOLEMON
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-2628
Mailing Address - Country:US
Mailing Address - Phone:318-335-2191
Mailing Address - Fax:
Practice Address - Street 1:1610 6TH ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554
Practice Address - Country:US
Practice Address - Phone:337-468-0487
Practice Address - Fax:337-468-0445
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10222104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker