Provider Demographics
NPI:1114659877
Name:DITTA, RANDI (LPC)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:DITTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22532 HIGHWAY 1088
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-8450
Mailing Address - Country:US
Mailing Address - Phone:985-705-7736
Mailing Address - Fax:985-317-0143
Practice Address - Street 1:22532 HIGHWAY 1088
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-8450
Practice Address - Country:US
Practice Address - Phone:985-705-7736
Practice Address - Fax:985-317-0143
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7723101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health