Provider Demographics
NPI:1457825796
Name:VIDRINE, WESTLEY ELICE
Entity Type:Individual
Prefix:
First Name:WESTLEY
Middle Name:ELICE
Last Name:VIDRINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 DURALDE HWY
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-1938
Mailing Address - Country:US
Mailing Address - Phone:337-224-0290
Mailing Address - Fax:
Practice Address - Street 1:4554 DURALDE HWY
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-1938
Practice Address - Country:US
Practice Address - Phone:337-224-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health