Healthcare Provider Details

I. General information

NPI: 1386474070
Provider Name (Legal Business Name): TREMECIA VIDEAU LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

IV. Provider business mailing address

PO BOX 784
SAINT GABRIEL LA
70776-0784
US

V. Phone/Fax

Practice location:
  • Phone: 225-802-1624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200018970
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: