Provider Demographics
NPI:1417588302
Name:WARREN, DENISE NICOLE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:NICOLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:NICOLE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2162
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2162
Mailing Address - Country:US
Mailing Address - Phone:985-551-5155
Mailing Address - Fax:
Practice Address - Street 1:1320 N MORRISON BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2242
Practice Address - Country:US
Practice Address - Phone:985-551-5155
Practice Address - Fax:985-551-5222
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator