Healthcare Provider Details

I. General information

NPI: 1356950125
Provider Name (Legal Business Name): RISHARD WINFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVENUE C
MARRERO LA
70072-3123
US

IV. Provider business mailing address

909 AVENUE C
MARRERO LA
70072-3123
US

V. Phone/Fax

Practice location:
  • Phone: 504-383-7448
  • Fax: 504-383-7448
Mailing address:
  • Phone: 504-383-7448
  • Fax: 504-383-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5594
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: