Provider Demographics
NPI:1619149101
Name:BADON, JACKIE R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:R
Last Name:BADON
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 1:501 FORSHAG LN
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-8122
Mailing Address - Country:US
Mailing Address - Phone:985-748-8411
Mailing Address - Fax:866-931-3991
Practice Address - Street 1:501 FORSHAG LN
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-8122
Practice Address - Country:US
Practice Address - Phone:985-748-8411
Practice Address - Fax:866-931-3991
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1927104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker