Provider Demographics
NPI:1003372905
Name:RIDDICK, ANDRE SR (LPCC)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:RIDDICK
Suffix:SR
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 WINCHESTER RD STE 147
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4179
Mailing Address - Country:US
Mailing Address - Phone:859-991-0710
Mailing Address - Fax:859-309-1791
Practice Address - Street 1:1301 WINCHESTER RD STE 147
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4179
Practice Address - Country:US
Practice Address - Phone:859-991-0710
Practice Address - Fax:859-309-1791
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288964101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor