Basic Information
| Provider Information | |||||||||
| NPI: | 1982068813 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AVENUES TO RECOVERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7133 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712117133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186801643 | ||||||||
| FaxNumber: | 3183420031 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 POWELL ST STE C | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712035352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186801643 | ||||||||
| FaxNumber: | 3183420031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2016 | ||||||||
| LastUpdateDate: | 04/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | MARSHALL | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3186801643 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.