Organization
CDS ASHLEY RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LAYNE BONVILLAIN LCSW (OWNER/CLINICAL DIRECTOR)
(318) 865-0039
Entity
Organization
Contact information
Practice address
460 ASHLEY RIDGE BLVD, SUITE 200, SHREVEPORT, LA 71106-7235
(318) 865-0039
(318) 865-1986
Mailing address
460 ASHLEY RIDGE BLVD, SUITE 200, SHREVEPORT, LA 71106-7235
(318) 865-0039
(318) 865-1986
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
316A
LA
Other
Enumeration date
07/16/2010
Last updated
07/16/2010
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