Provider Demographics
NPI:1972778512
Name:GRIEF RECOVERY CENTER
Entity Type:Organization
Organization Name:GRIEF RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:225-924-6621
Mailing Address - Street 1:4919 JAMESTOWN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3228
Mailing Address - Country:US
Mailing Address - Phone:225-924-6621
Mailing Address - Fax:225-924-6627
Practice Address - Street 1:4919 JAMESTOWN AVE STE 101
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3228
Practice Address - Country:US
Practice Address - Phone:225-924-6621
Practice Address - Fax:225-924-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty