1790044923 NPI number — MS. TOLONDA DYMETRIAS RICARD LPC

Table of content: MS. TOLONDA DYMETRIAS RICARD LPC (NPI 1790044923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790044923 NPI number — MS. TOLONDA DYMETRIAS RICARD LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICARD
Provider First Name:
TOLONDA
Provider Middle Name:
DYMETRIAS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGE
Provider Other First Name:
TOLONDA
Provider Other Middle Name:
RICARD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790044923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4821 LENNOX BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70131-8356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-723-3438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 BEHRMAN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRYTOWN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70056-4566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-723-3438
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2012

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: 101YP2500X , with the licence number:  3910 , 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)





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