Provider Demographics
NPI:1134205396
Name:ACADIANA AREA HUMAN SERVICES DISTRICT
Entity type:Organization
Organization Name:ACADIANA AREA HUMAN SERVICES DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH MANAGER-B
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-788-7511
Mailing Address - Street 1:1822 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-4720
Mailing Address - Country:US
Mailing Address - Phone:337-788-7511
Mailing Address - Fax:337-788-7588
Practice Address - Street 1:1822 W 2ND ST.
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526
Practice Address - Country:US
Practice Address - Phone:337-788-7511
Practice Address - Fax:337-788-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA482101YA0400X
LA117261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1710121Medicaid
LA1710121Medicaid