Provider Demographics
NPI:1306025713
Name:FREDIN, RONALD CRAIG (MA, LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:CRAIG
Last Name:FREDIN
Suffix:
Gender:M
Credentials:MA, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-0752
Mailing Address - Country:US
Mailing Address - Phone:504-458-0361
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH TYLER ST.
Practice Address - Street 2:SUITE 7A
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:504-458-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2414101YP2500X
LAMFT122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist