Provider Demographics
NPI:1255967766
Name:SANT'ANA, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:SANT'ANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:SANT'ANA
Other - Last Name:FLACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:33927 RENEE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-1123
Mailing Address - Country:US
Mailing Address - Phone:337-322-5471
Mailing Address - Fax:
Practice Address - Street 1:33927 RENEE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-1123
Practice Address - Country:US
Practice Address - Phone:337-322-5471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional