Provider Demographics
NPI:1275082851
Name:NOLA INTERVENTION, LLC
Entity Type:Organization
Organization Name:NOLA INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-602-7614
Mailing Address - Street 1:4300 S I 10 SERVICE RD W
Mailing Address - Street 2:103L
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 S I 10 SERVICE RD W
Practice Address - Street 2:103L
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-7405
Practice Address - Country:US
Practice Address - Phone:614-602-7614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10719742#2NJ62251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health