Provider Demographics
NPI:1013329911
Name:OLALDE, RICARDO (MS, CADC III, CRM)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:OLALDE
Suffix:
Gender:M
Credentials:MS, CADC III, CRM
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 356
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97344-0356
Mailing Address - Country:US
Mailing Address - Phone:503-373-7758
Mailing Address - Fax:503-301-6721
Practice Address - Street 1:FREEDOM & RECOVERY PROGRAM A D PROGRAM
Practice Address - Street 2:3405 DEER PARK DR. SE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97310-0001
Practice Address - Country:US
Practice Address - Phone:503-373-7758
Practice Address - Fax:503-378-6525
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR96-04-144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)