Provider Demographics
NPI:1043683352
Name:RIDINGS, FELICIA ANN (MS, PCA, CADC I)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:ANN
Last Name:RIDINGS
Suffix:
Gender:F
Credentials:MS, PCA, CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2879
Mailing Address - Country:US
Mailing Address - Phone:541-963-0627
Mailing Address - Fax:
Practice Address - Street 1:202 12TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2879
Practice Address - Country:US
Practice Address - Phone:541-963-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OR24-03-11048101YA0400X
ORR8306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136460Medicaid