Organization
FUNDAMENTALS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLETTE MELANCON LCSW (OWNER)
(504) 430-6116
Entity
Organization
Contact information
Practice address
60 LOUIS PRIMA DR, SUITE A, COVINGTON, LA 70433-5903
(504) 430-6116
(866) 300-8753
Mailing address
60 LOUIS PRIMA DR, SUITE A, COVINGTON, LA 70433-5903
(504) 430-6116
(866) 300-8753
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3700
LA
1041C0700X
Clinical Social Worker
3883
LA
Other
Enumeration date
11/12/2008
Last updated
01/20/2012
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