Provider Demographics
NPI:1346859584
Name:BLAIN, LATRICIA
Entity Type:Individual
Prefix:
First Name:LATRICIA
Middle Name:
Last Name:BLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-5470
Mailing Address - Country:US
Mailing Address - Phone:225-623-7296
Mailing Address - Fax:
Practice Address - Street 1:8706 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2233
Practice Address - Country:US
Practice Address - Phone:225-926-9706
Practice Address - Fax:225-926-9708
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
LAPLC8529171M00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator