Provider Demographics
NPI:1558956961
Name:ON THE MOVE FOR CHRIST FAITH BASED COUNSELING LLC
Entity Type:Organization
Organization Name:ON THE MOVE FOR CHRIST FAITH BASED COUNSELING LLC
Other - Org Name:OMC FAITH BASED COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROF CHRISTIAN THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAFONDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MTH, PSYD
Authorized Official - Phone:225-907-1698
Mailing Address - Street 1:9151 INTERLINE AVE
Mailing Address - Street 2:STE 9A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-1970
Mailing Address - Country:US
Mailing Address - Phone:225-907-1698
Mailing Address - Fax:225-416-6164
Practice Address - Street 1:9151 INTERLINE AVE STE 9A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1970
Practice Address - Country:US
Practice Address - Phone:225-907-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALH322367OtherLICENSED PROFESSIONAL CHRISTIAN THERAPIST