Basic Information
| Provider Information | |||||||||
| NPI: | 1114473196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARDNER | ||||||||
| FirstName: | CIARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8208 KINGVIEW ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JAMES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700867524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252067790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 LESSARD ST | ||||||||
| Address2: | |||||||||
| City: | DONALDSONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703462507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252574677 | ||||||||
| FaxNumber: | 2252574678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7229 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.