Provider Demographics
NPI:1366801730
Name:PROTECTIVE FACTORS, LLC
Entity type:Organization
Organization Name:PROTECTIVE FACTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEASANT-WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-450-2606
Mailing Address - Street 1:806 N 31ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3900
Mailing Address - Country:US
Mailing Address - Phone:318-737-7794
Mailing Address - Fax:318-605-4800
Practice Address - Street 1:806 N 31ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3900
Practice Address - Country:US
Practice Address - Phone:318-737-7794
Practice Address - Fax:318-605-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health