Active NPI
Mildred V Debarge, LAC
- Addiction (Substance Use Disorder) Counselor
- Lake Charles, LA
National Provider Identifier
1154574796
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 350
- Practice address
- 1709 W Prien Lake Rd
Lake Charles, LA 70601-8360 - Phone
- (337) 475-2557
- Fax
- (337) 266-5157
- NPI assigned
- Oct 28, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 350 | LA | Primary |
Addresses
Primary practice location
1709 W Prien Lake Rd
Lake Charles, LA 70601-8360
Mailing address
1709 W Prien Lake Rd
Lake Charles, LA 70601-8360
Phone (337) 475-2557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 350 | LA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225152000000",
"number": "1154574796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1709 W PRIEN LAKE RD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706018360",
"telephone_number": "337-475-2557",
"fax_number": "337-266-5157"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1709 W PRIEN LAKE RD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706018360",
"telephone_number": "337-475-2557",
"fax_number": "337-266-5157"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBARGE",
"first_name": "MILDRED",
"middle_name": "V",
"name_prefix": "Ms.",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-10-28",
"last_updated": "2008-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "LA",
"license": "350",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.