Provider Demographics
NPI:1134848856
Name:ANNETTE RIDLEY, LLC
Entity type:Organization
Organization Name:ANNETTE RIDLEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCDC
Authorized Official - Phone:281-293-9600
Mailing Address - Street 1:PO BOX 550382
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77255-0382
Mailing Address - Country:US
Mailing Address - Phone:281-293-9600
Mailing Address - Fax:
Practice Address - Street 1:11301 RICHMOND AVE STE K105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-5549
Practice Address - Country:US
Practice Address - Phone:281-293-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LONE STAR COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-25
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility