Provider Demographics
NPI:1568668242
Name:LAKESIDE COUNSELING CENTER
Entity Type:Organization
Organization Name:LAKESIDE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:SAGRERA
Authorized Official - Last Name:CUARTAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-293-0021
Mailing Address - Street 1:3350 RIDGELAKE DR
Mailing Address - Street 2:SUITE 86
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3836
Mailing Address - Country:US
Mailing Address - Phone:504-293-0021
Mailing Address - Fax:504-837-7988
Practice Address - Street 1:3350 RIDGELAKE DR
Practice Address - Street 2:SUITE 86
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3836
Practice Address - Country:US
Practice Address - Phone:504-293-0021
Practice Address - Fax:504-837-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA380251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health