Provider Demographics
NPI:1912384017
Name:UNIQUE'S PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:UNIQUE'S PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VONNCEDRIC
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:844-864-7834
Mailing Address - Street 1:5501 TULLIS DR
Mailing Address - Street 2:APT 2-103
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8907
Mailing Address - Country:US
Mailing Address - Phone:844-864-7834
Mailing Address - Fax:844-864-7834
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BUILDING 7, SUITE 9A
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-3950
Practice Address - Country:US
Practice Address - Phone:844-864-7834
Practice Address - Fax:844-864-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14432993251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health