Basic Information
| Provider Information | |||||||||
| NPI: | 1154865467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWAN | ||||||||
| FirstName: | BIANCA | ||||||||
| MiddleName: | SAD'E | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | GRETNA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700562558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043629010 | ||||||||
| FaxNumber: | 5043629070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1538 LOUISIANA AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048962345 | ||||||||
| FaxNumber: | 5048962240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2016 | ||||||||
| LastUpdateDate: | 04/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 6503637293902 | 05 | LA | MEDICAID |