Provider Demographics
NPI:1750646139
Name:PROFESSIONAL COUNSELING ALTERNATIVES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING ALTERNATIVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:225-910-2477
Mailing Address - Street 1:6486 HIGHWAY 44
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8158
Mailing Address - Country:US
Mailing Address - Phone:225-910-2477
Mailing Address - Fax:225-647-3213
Practice Address - Street 1:6486 HIGHWAY 44
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8158
Practice Address - Country:US
Practice Address - Phone:225-910-2477
Practice Address - Fax:225-647-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty