Provider Demographics
NPI:1306293691
Name:RICKSON, SHARDAE
Entity type:Individual
Prefix:
First Name:SHARDAE
Middle Name:
Last Name:RICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 WESTMINISTER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4434
Mailing Address - Country:US
Mailing Address - Phone:504-324-5298
Mailing Address - Fax:
Practice Address - Street 1:908 W JUDGE PEREZ DR STE C
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4774
Practice Address - Country:US
Practice Address - Phone:504-324-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health