Organization
DIVINE IMPACT BEHAVIORAL SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PATRICE NOEL PASLEY (OWNER)
(504) 330-0788
Entity
Organization
Contact information
Practice address
1799 STUMPF BLVD, BUILDING 5 SUITE 1, TERRYTOWN, LA 70056-3950
(504) 330-0788
Mailing address
1799 STUMPF BLVD, BUILDING 5 SUITE 1, TERRYTOWN, LA 70056-3950
(504) 330-0788
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
41056835
LA
Other
Enumeration date
02/18/2016
Last updated
02/18/2016
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