Provider Demographics
NPI:1316457971
Name:MADDEN, CLAIRE CONERLY (CIT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:CONERLY
Last Name:MADDEN
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2002
Mailing Address - Country:US
Mailing Address - Phone:318-222-8511
Mailing Address - Fax:318-222-3273
Practice Address - Street 1:2000 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2002
Practice Address - Country:US
Practice Address - Phone:318-222-8511
Practice Address - Fax:318-222-3273
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)