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Organization
MISS-LOU ADDICTION CLINIC
Active
Organization
MISS-LOU ADDICTION CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONA LISA PETERSON MS, BSW (EXECUTIVE DIRECTOR)
(601) 442-0270
Entity
Organization
Contact information
Practice address
525 ALEXANDER ST, JONESBORO, LA 71251-2001
(601) 442-0270
(888) 981-2815
Mailing address
1000 CHINABERRY DR STE 903, BOSSIER CITY, LA 71111-2455
(318) 459-6795
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
1112895
MS
Other
Enumeration date
09/01/2017
Last updated
07/21/2022
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