Provider Demographics
NPI:1912351362
Name:ABSHIRE, DWAYNE (LAC- AADC)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:ABSHIRE
Suffix:
Gender:M
Credentials:LAC- AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W PINHOOK RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3290
Mailing Address - Country:US
Mailing Address - Phone:337-591-0448
Mailing Address - Fax:337-234-2043
Practice Address - Street 1:2020 W PINHOOK RD
Practice Address - Street 2:SUITE 404
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3290
Practice Address - Country:US
Practice Address - Phone:337-591-0448
Practice Address - Fax:337-234-2043
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)