Provider Demographics
NPI:1982217758
Name:5TH DIMENSION RECOVERY CENTER
Entity Type:Organization
Organization Name:5TH DIMENSION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEATHA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ANATOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:337-280-1625
Mailing Address - Street 1:104 WINDRUSH LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7855
Mailing Address - Country:US
Mailing Address - Phone:337-280-1625
Mailing Address - Fax:
Practice Address - Street 1:630 WILSON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2154
Practice Address - Country:US
Practice Address - Phone:337-280-1625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:5TH DIMENSION RECOVERY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty