Basic Information
| Provider Information | |||||||||
| NPI: | 1366801730 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PROTECTIVE FACTORS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 N 31ST ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712013900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187377794 | ||||||||
| FaxNumber: | 3186054800 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 N 31ST ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712013900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187377794 | ||||||||
| FaxNumber: | 3186054800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2016 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | PLEASANT-WALLACE | ||||||||
| AuthorizedOfficialFirstName: | VICTORIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3184502606 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.