Provider Demographics
NPI:1245505593
Name:CENTERPOINT PINES TREATMENT CENTER
Entity type:Organization
Organization Name:CENTERPOINT PINES TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, B-LPC-S, LMHP
Authorized Official - Phone:318-632-2010
Mailing Address - Street 1:6325 BOCAGE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119-6228
Mailing Address - Country:US
Mailing Address - Phone:318-636-3113
Mailing Address - Fax:
Practice Address - Street 1:6325 BOCAGE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71119-6228
Practice Address - Country:US
Practice Address - Phone:318-636-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA475324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility