Organization
RIVERPARK COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN FAIRBANKS MD (OWNER)
(318) 336-2212
Entity
Organization
Contact information
Practice address
107 FRONT ST, STE 2134, VIDALIA, LA 71373-2836
(318) 336-2212
Mailing address
107 FRONT ST, STE 2134, VIDALIA, LA 71373-2836
(318) 336-2212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12091
LA
Other
Enumeration date
03/11/2015
Last updated
03/11/2015
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