Provider Demographics
NPI:1063828705
Name:RICKENBRODE, JOYCE MARIE
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:MARIE
Last Name:RICKENBRODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:MARIE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 GEORGIA STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5905
Mailing Address - Country:US
Mailing Address - Phone:707-534-6065
Mailing Address - Fax:
Practice Address - Street 1:251 GEORGIA STREET
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5905
Practice Address - Country:US
Practice Address - Phone:707-534-6065
Practice Address - Fax:707-237-3154
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)