Provider Demographics
NPI:1588003875
Name:DAUTERIVE, VIRGINIA RUTH (MSW, CSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:RUTH
Last Name:DAUTERIVE
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARLSON PKWY N
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4466
Mailing Address - Country:US
Mailing Address - Phone:855-482-6237
Mailing Address - Fax:855-763-2748
Practice Address - Street 1:8550 UNITED PLAZA BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2256
Practice Address - Country:US
Practice Address - Phone:855-482-6237
Practice Address - Fax:855-763-2748
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12267104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker