Basic Information
| Provider Information | |||||||||
| NPI: | 1710266010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELCHAMPS | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | EYES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 822 S CLEARVIEW PKWY | ||||||||
| Address2: | |||||||||
| City: | HARAHAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701233401 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 822 S CLEARVIEW PKWY | ||||||||
| Address2: | |||||||||
| City: | HARAHAN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701233401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044844123 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2011 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 11400 | LA | N | Behavioral Health & Social Service Providers | Social Worker | 1041S0200X | Y | Behavioral Health & Social Service Providers | Social Worker | School |
ID Information
| ID | Type | State | Issuer | Description | 1701033 | 05 | LA | MEDICAID |