Provider Demographics
NPI:1497016083
Name:IBERVILLE PARISH SUBSTANCE ABUSE CENTER
Entity Type:Organization
Organization Name:IBERVILLE PARISH SUBSTANCE ABUSE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:ALLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-687-5889
Mailing Address - Street 1:24705 PLAZA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-6827
Mailing Address - Country:US
Mailing Address - Phone:225-687-5889
Mailing Address - Fax:225-687-5893
Practice Address - Street 1:24705 PLAZA DR
Practice Address - Street 2:SUITE B
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6827
Practice Address - Country:US
Practice Address - Phone:225-687-5889
Practice Address - Fax:225-687-5893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IBERVILLE PARISH COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA241101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty