Provider Demographics
NPI:1336275148
Name:FAUCHEUX, ANITA ROCK (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ROCK
Last Name:FAUCHEUX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LAKELAWN DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5750
Mailing Address - Country:US
Mailing Address - Phone:985-502-9020
Mailing Address - Fax:985-649-0408
Practice Address - Street 1:550 OLD SPANISH TRL STE F
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4051
Practice Address - Country:US
Practice Address - Phone:985-502-9020
Practice Address - Fax:985-649-0408
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2861101YP2500X
LA812106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist