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Individual

CHAD FREDERICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
617 S TRENTON ST, RUSTON, LA 71270-5040
(318) 251-4659
(318) 251-4659
Mailing address
617 S TRENTON ST, RUSTON, LA 71270-5040
(318) 251-4659
(318) 251-4659

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3129
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1345897
LA
Enumeration date
06/30/2014
Last updated
06/30/2014
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