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Organization

NORTHLAKE COUNSELING AND CONSULTING

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS JESSICA G GANDOLFO LPC, LMFT (OWNER)
(985) 687-5226
Entity
Organization

Contact information

Practice address
485 S 8TH ST, PONCHATOULA, LA 70454-3415
(985) 687-5226
(866) 657-7188
Mailing address
902 C M FAGAN DR, UNIT B, HAMMOND, LA 70403-6043
(985) 687-5226
(866) 657-7188

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2753
LA
106H00000X
Marriage & Family Therapist
1123
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1740457092
INDIVIDUAL NPI
LA
Enumeration date
06/04/2012
Last updated
06/04/2012
Update your record

If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.

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