Provider Demographics
NPI:1710236864
Name:ADRIENNE PIZZA BRINK LLC
Entity Type:Organization
Organization Name:ADRIENNE PIZZA BRINK LLC
Other - Org Name:ADRIENNE PIZZA BRINK, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:PIZZA
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:985-285-8081
Mailing Address - Street 1:1444 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2849
Mailing Address - Country:US
Mailing Address - Phone:985-285-8081
Mailing Address - Fax:
Practice Address - Street 1:2836 FRONT ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4334
Practice Address - Country:US
Practice Address - Phone:985-285-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4495101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty