Provider Demographics
NPI:1104077254
Name:STOCKDREHER, THERESA KAY
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:STOCKDREHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:STOCKDREHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GSW
Mailing Address - Street 1:1515 POYDRAS ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-3723
Mailing Address - Country:US
Mailing Address - Phone:504-872-0781
Mailing Address - Fax:
Practice Address - Street 1:1515 POYDRAS ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3723
Practice Address - Country:US
Practice Address - Phone:504-872-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9481104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker