Healthcare Provider Details

I. General information

NPI: 1770177362
Provider Name (Legal Business Name): LAURIE LIDIE, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4971 BONNYVIEW AVE
REDDING CA
96001-4217
US

IV. Provider business mailing address

4971 BONNYVIEW AVE
REDDING CA
96001-4217
US

V. Phone/Fax

Practice location:
  • Phone: 530-604-3637
  • Fax:
Mailing address:
  • Phone: 530-604-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAURIE LIDIE
Title or Position: OWNER
Credential:
Phone: 530-604-3637