Provider Demographics
NPI:1275733248
Name:AL-JABI, ANISA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANISA
Middle Name:MARIE
Last Name:AL-JABI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61843
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-1843
Mailing Address - Country:US
Mailing Address - Phone:337-237-1353
Mailing Address - Fax:337-237-1353
Practice Address - Street 1:1304 BERTRAND DR
Practice Address - Street 2:STE E6
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-9105
Practice Address - Country:US
Practice Address - Phone:337-237-1353
Practice Address - Fax:337-237-1353
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA77961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical