Provider Demographics
NPI:1336586155
Name:PETERKIN AND ASSOCIATES OF LOUISIANA, INC.
Entity Type:Organization
Organization Name:PETERKIN AND ASSOCIATES OF LOUISIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-759-9472
Mailing Address - Street 1:5093 DOWD RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71229-9180
Mailing Address - Country:US
Mailing Address - Phone:910-759-9472
Mailing Address - Fax:
Practice Address - Street 1:5093 DOWD RD
Practice Address - Street 2:
Practice Address - City:COLLINSTON
Practice Address - State:LA
Practice Address - Zip Code:71229-9180
Practice Address - Country:US
Practice Address - Phone:910-759-9472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health