Provider Demographics
NPI:1629408406
Name:FPHSA WASHINGTON ADDICTIVE DISORDERS CLINIC
Entity Type:Organization
Organization Name:FPHSA WASHINGTON ADDICTIVE DISORDERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-748-2220
Mailing Address - Street 1:619 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3001
Mailing Address - Country:US
Mailing Address - Phone:985-732-6610
Mailing Address - Fax:985-732-6626
Practice Address - Street 1:619 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3001
Practice Address - Country:US
Practice Address - Phone:985-732-6610
Practice Address - Fax:985-732-6626
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PARISHES HUMAN SERVICES AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA192251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health