Provider Demographics
NPI:1609658327
Name:NOLA PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:NOLA PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:504-383-3033
Mailing Address - Street 1:5302 DAUPHINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-3732
Mailing Address - Country:US
Mailing Address - Phone:504-383-3033
Mailing Address - Fax:833-799-3463
Practice Address - Street 1:5302 DAUPHINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70117-3732
Practice Address - Country:US
Practice Address - Phone:504-383-3033
Practice Address - Fax:833-799-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty