Provider Demographics
NPI:1760762470
Name:JACQUELINE A. DANZELL, LCSW, LLC
Entity Type:Organization
Organization Name:JACQUELINE A. DANZELL, LCSW, LLC
Other - Org Name:DBA OASIS COMMUNITY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-861-8625
Mailing Address - Street 1:910 PIERREMONT RD STE 410
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2056
Mailing Address - Country:US
Mailing Address - Phone:318-861-8625
Mailing Address - Fax:318-861-8626
Practice Address - Street 1:910 PIERREMONT RD STE 410
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2056
Practice Address - Country:US
Practice Address - Phone:318-861-8625
Practice Address - Fax:318-861-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty