Individual
KIM A WISE-GASTINELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AD.D
Contact information
Practice address
5635 TARRYTOWN AVE, BATON ROUGE, LA 70808-3535
(225) 476-3809
(225) 256-2668
Mailing address
1000 CHINABERRY DR STE 900, BOSSIER CITY, LA 71111-2455
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
PLC9874
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PLC9874
—
LA
Enumeration date
02/24/2016
Last updated
03/12/2026
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