Individual
MR. ROGER D BENNETT I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.A.C.
Contact information
Practice address
2495 SHREVEPORT HWY, ALEXANDRIA, LA 71306-9004
(318) 473-0010
(318) 483-5176
Mailing address
PO BOX 69004, ALEXANDRIA, LA 71306-9004
(318) 473-0010
(318) 483-5176
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
635
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3499
ADDICTION SPECALIST
MA
01
—
635
LICENSEADICTIONCOUNSELOR
LA
Enumeration date
10/20/2006
Last updated
07/08/2007
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