Organization
FAMILY LIFE DEVELOPMENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALPHONSO BINGHAM M.S. (ADMINISTRATOR/CEO)
(318) 255-8405
Entity
Organization
Contact information
Practice address
829 E GEORGIA AVE STE 5, RUSTON, LA 71270-3901
(318) 255-8405
(318) 255-8417
Mailing address
829 E GEORGIA AVE STE 5, RUSTON, LA 71270-3901
(318) 255-8405
(318) 255-8417
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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