Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 831 | LA |
NPI | 1003834417 |
---|---|
Provider Name | Ms. Mary Louise Lewis |
First Address | West Monroe, LA 71291-8142 |
Second Address | Monroe, LA 71201-5113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |