Provider Demographics
NPI:1275771354
Name:CENLA WELLNESS CENTER, LLC.
Entity Type:Organization
Organization Name:CENLA WELLNESS CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-449-8571
Mailing Address - Street 1:3818A BAYOU RAPIDES RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3655
Mailing Address - Country:US
Mailing Address - Phone:314-449-8571
Mailing Address - Fax:318-449-8506
Practice Address - Street 1:3818A BAYOU RAPIDES RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3655
Practice Address - Country:US
Practice Address - Phone:314-449-8571
Practice Address - Fax:318-449-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3568101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty