Provider Demographics
NPI:1659791408
Name:POOLE, LOVIE JACKSON (LPC)
Entity Type:Individual
Prefix:
First Name:LOVIE
Middle Name:JACKSON
Last Name:POOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-6531
Mailing Address - Country:US
Mailing Address - Phone:504-367-3017
Mailing Address - Fax:594-367-3017
Practice Address - Street 1:3017 WABASH ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-6531
Practice Address - Country:US
Practice Address - Phone:504-367-3017
Practice Address - Fax:594-367-3017
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1210101YA0400X
LA3550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)