Provider Demographics
NPI:1174060925
Name:TOLDSON, IVAN (RAC)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:TOLDSON
Suffix:
Gender:M
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66558
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6558
Mailing Address - Country:US
Mailing Address - Phone:225-925-1906
Mailing Address - Fax:225-362-5314
Practice Address - Street 1:4615 GOVERNMENT ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5922
Practice Address - Country:US
Practice Address - Phone:225-925-1906
Practice Address - Fax:225-362-5314
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 175T00000X
LA1512101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist