Provider Demographics
NPI:1821131913
Name:RIVER CITY PROFESSIONAL COUNSELING, LLC
Entity Type:Organization
Organization Name:RIVER CITY PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOUBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:318-325-8782
Mailing Address - Street 1:141 DESIARD ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7385
Mailing Address - Country:US
Mailing Address - Phone:318-325-8782
Mailing Address - Fax:318-325-8749
Practice Address - Street 1:141 DESIARD ST
Practice Address - Street 2:SUITE 507
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7385
Practice Address - Country:US
Practice Address - Phone:318-325-8782
Practice Address - Fax:318-325-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5183104100000X
LA787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CS89Medicare ID - Type Unspecified