Provider Demographics
NPI:1831976638
Name:ALEXANDRIA DEPENDENCY AND MENTAL HEALTH, LLC.
Entity type:Organization
Organization Name:ALEXANDRIA DEPENDENCY AND MENTAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-C
Authorized Official - Phone:318-632-7878
Mailing Address - Street 1:3009 LEGACY LOOP
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4661
Mailing Address - Country:US
Mailing Address - Phone:318-632-7878
Mailing Address - Fax:318-643-4484
Practice Address - Street 1:44 VERSAILLES BOULEVARD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303
Practice Address - Country:US
Practice Address - Phone:318-792-7575
Practice Address - Fax:318-225-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty