1639851272 NPI number — ADRIANA GABRIELLE ASCENCIO LCSW

Table of content: ADRIANA GABRIELLE ASCENCIO LCSW (NPI 1639851272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639851272 NPI number — ADRIANA GABRIELLE ASCENCIO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASCENCIO
Provider First Name:
ADRIANA
Provider Middle Name:
GABRIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPURLOCK
Provider Other First Name:
ADRIANA
Provider Other Middle Name:
GABRIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639851272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2223 OLD MINDEN RD STE A1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSSIER CITY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71112-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-726-2063
Provider Business Mailing Address Fax Number:
318-333-1647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2223 OLD MINDEN RD STE A1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSSIER CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71112-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-726-2063
Provider Business Practice Location Address Fax Number:
318-333-1647
Provider Enumeration Date:
08/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  14901 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3080950 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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