Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 101YP2500X | Professional Counselor | LH322367 | LA |
NPI | 1043771132 |
---|---|
Provider Name | La'fonda Nicole Heard |
First Address | Baton Rouge, LA 70809-1970 |
Second Address | Baton Rouge, LA 70809-1970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2019 |
Last Update Date | 21/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LH322367 | LICENSED PROFESSIONAL CHRISTIAN THERAPIST (01) | LA |