Provider Demographics
NPI:1659737070
Name:LACOSTE, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:LACOSTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PAPWORTH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3010
Mailing Address - Country:US
Mailing Address - Phone:504-874-4626
Mailing Address - Fax:
Practice Address - Street 1:701 PAPWORTH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3010
Practice Address - Country:US
Practice Address - Phone:504-874-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4785101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional