Provider Demographics
NPI:1932316221
Name:ST JAMES COMMUNITY FRESH START PROGRAM
Entity Type:Organization
Organization Name:ST JAMES COMMUNITY FRESH START PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DAVIS WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD NBCC
Authorized Official - Phone:225-623-9751
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-0850
Mailing Address - Country:US
Mailing Address - Phone:225-258-4029
Mailing Address - Fax:225-258-4109
Practice Address - Street 1:108 N EZIDORE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-0850
Practice Address - Country:US
Practice Address - Phone:225-258-4029
Practice Address - Fax:225-258-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty