Provider Demographics
NPI:1013224799
Name:RIGDON, TAMRA (LSW,LAC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:RIGDON
Suffix:
Gender:F
Credentials:LSW,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-4054
Mailing Address - Country:US
Mailing Address - Phone:765-393-2283
Mailing Address - Fax:800-737-4201
Practice Address - Street 1:3805 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4054
Practice Address - Country:US
Practice Address - Phone:765-393-2283
Practice Address - Fax:765-737-4201
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000165A101YA0400X
IN33005995A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)