Provider Demographics
NPI:1881954576
Name:SESA SUBAN WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:SESA SUBAN WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:504-931-3945
Mailing Address - Street 1:2714 CANAL ST
Mailing Address - Street 2:407
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5548
Mailing Address - Country:US
Mailing Address - Phone:504-827-2115
Mailing Address - Fax:504-827-2116
Practice Address - Street 1:2714 CANAL ST
Practice Address - Street 2:407
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5548
Practice Address - Country:US
Practice Address - Phone:504-827-2115
Practice Address - Fax:504-827-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA97111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty