Provider Demographics
NPI:1326021205
Name:RIDDICK, CHRISTOPHER CHARLES (LPC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:RIDDICK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 S DENTON TAP RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4098
Mailing Address - Country:US
Mailing Address - Phone:972-393-1596
Mailing Address - Fax:972-304-0400
Practice Address - Street 1:580 S DENTON TAP RD
Practice Address - Street 2:SUITE 270
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4098
Practice Address - Country:US
Practice Address - Phone:972-393-1596
Practice Address - Fax:972-304-0400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional