Provider Demographics
NPI:1407116015
Name:NORTHEAST LA. SUBSTANCE ABUSE CLINIC
Entity Type:Organization
Organization Name:NORTHEAST LA. SUBSTANCE ABUSE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SIERRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:318-435-7558
Mailing Address - Street 1:809 JULIA ST
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-2648
Mailing Address - Country:US
Mailing Address - Phone:318-728-2057
Mailing Address - Fax:
Practice Address - Street 1:809 JULIA ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2648
Practice Address - Country:US
Practice Address - Phone:318-728-2057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251B00000X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management