Provider Demographics
NPI:1770010761
Name:PRICE, CARLOS JAMAAL
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAMAAL
Last Name:PRICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 STUBBS AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5566
Mailing Address - Country:US
Mailing Address - Phone:318-512-4997
Mailing Address - Fax:318-600-6095
Practice Address - Street 1:801 STUBBS AVE STE E
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5566
Practice Address - Country:US
Practice Address - Phone:318-512-4997
Practice Address - Fax:318-600-6095
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor