Basic Information
| Provider Information | |||||||||
| NPI: | 1134463276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDHOM | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8222 COHN ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701182804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043197428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 W ESPLANADE AVE S | ||||||||
| Address2: | SUITE 213 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700027406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385215 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2012 | ||||||||
| LastUpdateDate: | 11/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 4597 | LA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.