Provider Demographics
NPI:1407064538
Name:SMALL, DORIS A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:A
Last Name:SMALL
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 1:123 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457
Mailing Address - Country:US
Mailing Address - Phone:318-646-3705
Mailing Address - Fax:318-646-3705
Practice Address - Street 1:123 BROWNVILLE RD
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-8640
Practice Address - Country:US
Practice Address - Phone:318-646-3705
Practice Address - Fax:318-646-3705
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2069104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1914002Medicaid
5S316Medicare ID - Type Unspecified