Provider Demographics
NPI:1023572807
Name:ANDREA VIDRINE
Entity Type:Organization
Organization Name:ANDREA VIDRINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDRINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-288-7022
Mailing Address - Street 1:630 S CORPORATION ST
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-4208
Mailing Address - Country:US
Mailing Address - Phone:337-288-7022
Mailing Address - Fax:
Practice Address - Street 1:1000 W PINHOOK RD STE 311
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-288-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty