Provider Demographics
NPI:1497083224
Name:DISHONGH, ERIC M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:DISHONGH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-3092
Mailing Address - Country:US
Mailing Address - Phone:504-606-1267
Mailing Address - Fax:504-737-0005
Practice Address - Street 1:2201 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-1613
Practice Address - Country:US
Practice Address - Phone:504-606-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3602101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional