Provider Demographics
NPI:1366800328
Name:DIVERSION YOUTH AND FAMILY COUNSELING LLC
Entity type:Organization
Organization Name:DIVERSION YOUTH AND FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-270-6647
Mailing Address - Street 1:12524 MERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2494
Mailing Address - Country:US
Mailing Address - Phone:225-270-6647
Mailing Address - Fax:
Practice Address - Street 1:12524 MERLIN AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2494
Practice Address - Country:US
Practice Address - Phone:225-270-6647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty