Provider Demographics
NPI:1417497538
Name:DAUPHINE, LINDA MAE (CIT 2352)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MAE
Last Name:DAUPHINE
Suffix:
Gender:F
Credentials:CIT 2352
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-4740
Mailing Address - Country:US
Mailing Address - Phone:337-231-6365
Mailing Address - Fax:337-231-6371
Practice Address - Street 1:100 POYDRAS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-4740
Practice Address - Country:US
Practice Address - Phone:337-231-6365
Practice Address - Fax:337-231-6371
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2352101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)