Provider Demographics
NPI:1508310806
Name:BEHAVIORAL MEDICINE & ADDICTIVE DISORDERS, INC.
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE & ADDICTIVE DISORDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:318-681-8100
Mailing Address - Street 1:7330 FERN AVE STE 502
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4983
Mailing Address - Country:US
Mailing Address - Phone:318-681-8100
Mailing Address - Fax:318-681-8106
Practice Address - Street 1:7330 FERN AVE STE 502
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4983
Practice Address - Country:US
Practice Address - Phone:318-681-8100
Practice Address - Fax:318-681-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5599101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty