Provider Demographics
NPI:1265950745
Name:DEVILLE, TAMIKA NICOLE
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:NICOLE
Last Name:DEVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 STUMPF BLVD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3950
Mailing Address - Country:US
Mailing Address - Phone:504-407-0755
Mailing Address - Fax:504-407-0778
Practice Address - Street 1:ADVANCED THERAPEUTIC
Practice Address - Street 2:1799 STUMPF BLVD BLD 3 STE 4B
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-407-0755
Practice Address - Fax:504-407-0778
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health