Provider Demographics
NPI:1710169503
Name:RIVER CITY PROFESSIONAL COUNSELING
Entity Type:Organization
Organization Name:RIVER CITY PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DOUBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-325-8748
Mailing Address - Street 1:1210 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5622
Mailing Address - Country:US
Mailing Address - Phone:318-325-8782
Mailing Address - Fax:
Practice Address - Street 1:1210 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5622
Practice Address - Country:US
Practice Address - Phone:318-325-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2203782133OtherBEHAVIORAL HEALTH LICENSE
5DQ56OtherMEDICARE
LA2203782133OtherSUBSTANCE ABUSE FACILITY LICENSE