Provider Demographics
NPI:1992042634
Name:LOUISIANA ADDICTION SERVICES, LLC
Entity Type:Organization
Organization Name:LOUISIANA ADDICTION SERVICES, LLC
Other - Org Name:DENHAM SPRINGS ADDICTIVE DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA LAC CCS SAP
Authorized Official - Phone:225-243-5573
Mailing Address - Street 1:1295 FLORIDA AVE SW
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4635
Mailing Address - Country:US
Mailing Address - Phone:225-243-5573
Mailing Address - Fax:225-243-6029
Practice Address - Street 1:1295 FLORIDA AVE SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4635
Practice Address - Country:US
Practice Address - Phone:225-243-5573
Practice Address - Fax:225-243-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA576101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty