Provider Demographics
NPI:1720390495
Name:CENTER FOR PERSONAL DEVELOPMENT INC
Entity Type:Organization
Organization Name:CENTER FOR PERSONAL DEVELOPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORIA
Authorized Official - Middle Name:SHELA
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:318-512-1257
Mailing Address - Street 1:1900 LAMY LN STE H
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-9200
Mailing Address - Country:US
Mailing Address - Phone:318-361-0590
Mailing Address - Fax:318-329-0239
Practice Address - Street 1:1900 LAMY LN STE H
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-9200
Practice Address - Country:US
Practice Address - Phone:318-361-0590
Practice Address - Fax:318-329-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27028251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1813311Medicaid