Basic Information
| Provider Information | |||||||||
| NPI: | 1669925707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPERANZA | ||||||||
| FirstName: | CARE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LAC, PLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 MARTIN LUTHER KING JR DR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705011884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372332437 | ||||||||
| FaxNumber: | 3372346067 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 MARTIN LUTHER KING JR DR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705011884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372332437 | ||||||||
| FaxNumber: | 3372346067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2016 | ||||||||
| LastUpdateDate: | 04/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LAC1355 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | PLC7007 | LA | N | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.