Provider Demographics
NPI:1821486614
Name:DESJARDINS, CHRISTINE (MED)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:DESJARDINS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6511
Mailing Address - Country:US
Mailing Address - Phone:985-624-2942
Mailing Address - Fax:985-231-1373
Practice Address - Street 1:633 ASBURY DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6511
Practice Address - Country:US
Practice Address - Phone:985-624-2942
Practice Address - Fax:985-231-1373
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health