Provider Demographics
NPI:1144470253
Name:WORDLAW, CATRINA NICOLE (MS, MHP, PLPC)
Entity type:Individual
Prefix:MS
First Name:CATRINA
Middle Name:NICOLE
Last Name:WORDLAW
Suffix:
Gender:F
Credentials:MS, MHP, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 KNIGHT ST STE 270
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2554
Mailing Address - Country:US
Mailing Address - Phone:318-658-0069
Mailing Address - Fax:
Practice Address - Street 1:3020 KNIGHT ST STE 270
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2554
Practice Address - Country:US
Practice Address - Phone:318-658-0069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPLC10454101YP2500X
171M00000X, 101YM0800X
LAPLC10454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018214Medicaid