Provider Demographics
NPI:1386036986
Name:RIDDLE, DANIELLE
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:RIDDLE
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 1:8100 WYOMING BLVD NE STE M4-147
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1946
Mailing Address - Country:US
Mailing Address - Phone:505-585-1225
Mailing Address - Fax:505-375-6041
Practice Address - Street 1:8100 WYOMING BLVD NE # M4-147
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1946
Practice Address - Country:US
Practice Address - Phone:505-585-1225
Practice Address - Fax:505-375-6041
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005709101YP2500X
101YP2500X
NM0169371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional