Provider Demographics
NPI:1700341393
Name:REWIRED, COUNSELING AND BRAINSPOTTING, LLC
Entity Type:Organization
Organization Name:REWIRED, COUNSELING AND BRAINSPOTTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOISE-FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:985-288-1315
Mailing Address - Street 1:47191 BENDER RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-6829
Mailing Address - Country:US
Mailing Address - Phone:985-288-1315
Mailing Address - Fax:
Practice Address - Street 1:1250 SW RAILROAD AVE STE 170
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5011
Practice Address - Country:US
Practice Address - Phone:985-288-1315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty