Provider Demographics
NPI:1922080902
Name:DUGAS, MALCOLM JAMES JR (MSW,LCSW,ACSW)
Entity Type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:JAMES
Last Name:DUGAS
Suffix:JR
Gender:M
Credentials:MSW,LCSW,ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20355
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-0355
Mailing Address - Country:US
Mailing Address - Phone:985-209-1974
Mailing Address - Fax:985-872-4707
Practice Address - Street 1:209 BAYOU GARDENS BLVD.
Practice Address - Street 2:SUITE 403
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-1420
Practice Address - Country:US
Practice Address - Phone:985-209-1974
Practice Address - Fax:985-872-4707
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA46151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1470848Medicaid
LA161697834OtherTAX ID NUMBER
LA161697834OtherTAX ID NUMBER