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General NPI Number Information
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NPI Number | 1134848856
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Entity Type | Organization
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Legal Business Name | ANNETTE RIDLEY, LLC
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 11301 RICHMOND AVE STE K105
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City | HOUSTON
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State | TX
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Zip | 77082-5549
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Country | US
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Telephone | 281-293-9600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 550382
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City | HOUSTON
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State | TX
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Zip | 77255-0382
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Country | US
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Telephone | 281-293-9600
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. CHARLES R FONTENOT JR.
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Credential | LCDC
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Telephone | 281-293-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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