Basic Information
Provider Information | |||||||||
NPI: | 1972644102 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARRETT | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | HAMILTON | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | GSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 156 | ||||||||
Address2: |   | ||||||||
City: | ZACHARY | ||||||||
State: | LA | ||||||||
PostalCode: | 707910156 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2259361923 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 12126 LIBERTY ST | ||||||||
Address2: |   | ||||||||
City: | CLINTON | ||||||||
State: | LA | ||||||||
PostalCode: | 707223017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2256838877 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/09/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 9297 | LA | Y |   | Behavioral Health & Social Service Providers | Social Worker | School |
ID Information
ID | Type | State | Issuer | Description | 9297 | 01 | LA | GSW CERTIFICATION | OTHER |