Individual
EBONY WILRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
114 CURRAN LN STE A-1, LAFAYETTE, LA 70506-7222
(337) 703-3037
(337) 340-9280
Mailing address
310 E RACCA RD, JENNINGS, LA 70546-7822
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11260
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043682016
—
LA
Enumeration date
10/29/2015
Last updated
12/21/2020
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