Provider Demographics
NPI:1659403921
Name:CHEMICAL DEPENDENCY SERVICES, LLC
Entity Type:Organization
Organization Name:CHEMICAL DEPENDENCY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAYNE
Authorized Official - Last Name:BONVILLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-425-3333
Mailing Address - Street 1:1545 LINE AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4629
Mailing Address - Country:US
Mailing Address - Phone:318-425-3333
Mailing Address - Fax:225-208-1850
Practice Address - Street 1:1545 LINE AVE STE 170
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4629
Practice Address - Country:US
Practice Address - Phone:318-425-3333
Practice Address - Fax:225-208-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA316101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty