Provider Demographics
NPI:1518467711
Name:RIDEAU, CHRIS DARRELL
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:DARRELL
Last Name:RIDEAU
Suffix:
Gender:M
Credentials:
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 236
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:LA
Mailing Address - Zip Code:70584-0236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6212
Practice Address - Country:US
Practice Address - Phone:337-212-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1578828851Medicaid
LA157882652Medicaid