Provider Demographics
NPI:1710149810
Name:MONROE ADDICTIVE DISORDER CLINIC
Entity Type:Organization
Organization Name:MONROE ADDICTIVE DISORDER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSLEOR 4
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANGELA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:318-362-5188
Mailing Address - Street 1:3200 CONCORDIA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5113
Mailing Address - Country:US
Mailing Address - Phone:318-362-5188
Mailing Address - Fax:318-362-5215
Practice Address - Street 1:3200 CONCORDIA AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5113
Practice Address - Country:US
Practice Address - Phone:318-362-5188
Practice Address - Fax:318-362-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility