Provider Demographics
NPI:1568633972
Name:HARGRAVE GAD, MARIE ALANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ALANA
Last Name:HARGRAVE GAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 AMBASSADOR CAFFERY PARKWAY
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508
Mailing Address - Country:US
Mailing Address - Phone:337-706-8960
Mailing Address - Fax:
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PARKWAY
Practice Address - Street 2:BUILDING 4
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-706-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA83891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical