Basic Information
| Provider Information | |||||||||
| NPI: | 1679633218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | ALICE | ||||||||
| MiddleName: | WELLS | ||||||||
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| Credential: | GSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4615 GOVERNMENT ST BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259251741 | ||||||||
| FaxNumber: | 2259220771 | ||||||||
| Practice Location | |||||||||
| Address1: | 4615 GOVERNMENT ST BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708065820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259251741 | ||||||||
| FaxNumber: | 2259220771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 104100000X | 6158 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.