Provider Demographics
NPI:1457808750
Name:PAUL, LLWENDELLYN
Entity type:Individual
Prefix:
First Name:LLWENDELLYN
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3115
Mailing Address - Country:US
Mailing Address - Phone:318-336-4797
Mailing Address - Fax:318-336-4799
Practice Address - Street 1:206 E REYNOLDS DR STE F
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2873
Practice Address - Country:US
Practice Address - Phone:318-254-7050
Practice Address - Fax:318-254-7053
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health