Provider Demographics
NPI:1235518515
Name:SAVOIE, DWIGHT (MED)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:
Last Name:SAVOIE
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:DWIGHT
Other - Middle Name:
Other - Last Name:SAVIOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-0236
Mailing Address - Country:US
Mailing Address - Phone:337-662-3737
Mailing Address - Fax:337-662-3636
Practice Address - Street 1:123 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:GRAND COTEAU
Practice Address - State:LA
Practice Address - Zip Code:70541-7054
Practice Address - Country:US
Practice Address - Phone:337-662-3737
Practice Address - Fax:337-662-3636
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
LA2320807101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2320807Medicaid