Basic Information
| Provider Information | |||||||||
| NPI: | 1821131913 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER CITY PROFESSIONAL COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 DESIARD ST | ||||||||
| Address2: | SUITE 507 | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712017385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183258782 | ||||||||
| FaxNumber: | 3183258749 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 DESIARD ST | ||||||||
| Address2: | SUITE 507 | ||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712017385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183258782 | ||||||||
| FaxNumber: | 3183258749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOUBLIN | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3183258782 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW, LMFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 5183 | LA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | 787 | LA | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.