Basic Information
| Provider Information | |||||||||
| NPI: | 1366817546 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUMAS | ||||||||
| FirstName: | JUVANIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 726 SAINT MAURICE AVE | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701171542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5047089225 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 615 BARONNE ST STE 304 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701131054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048148001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2015 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 11/21/2018 | ||||||||
| NPIReactivationDate: | 03/20/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5318 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 14219730 | 01 | LA | CAQH PROVIDER ID | OTHER |