Provider Demographics
NPI:1922217785
Name:CHOICES ON THE NORTHSHORE
Entity Type:Organization
Organization Name:CHOICES ON THE NORTHSHORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEFFERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, LAC
Authorized Official - Phone:985-624-2267
Mailing Address - Street 1:2107 N CAUSEWAY BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-1829
Mailing Address - Country:US
Mailing Address - Phone:985-624-2267
Mailing Address - Fax:
Practice Address - Street 1:2107 N CAUSEWAY BLVD STE E
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1829
Practice Address - Country:US
Practice Address - Phone:985-624-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASA0007136251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health