Provider Demographics
NPI:1265015119
Name:THE DRAGONFLY HARBOR, INC.
Entity Type:Organization
Organization Name:THE DRAGONFLY HARBOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-A
Authorized Official - Phone:318-953-1950
Mailing Address - Street 1:2307 LILY DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-2622
Mailing Address - Country:US
Mailing Address - Phone:318-953-1950
Mailing Address - Fax:
Practice Address - Street 1:2307 LILY DR
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2622
Practice Address - Country:US
Practice Address - Phone:318-953-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty