Provider Demographics
NPI:1467197871
Name:RIDDICK, RENITA LYNN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RENITA
Middle Name:LYNN
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 HUNGERFORD DR STE 119
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5148
Mailing Address - Country:US
Mailing Address - Phone:202-963-0771
Mailing Address - Fax:202-886-1203
Practice Address - Street 1:5750 EXECUTIVE DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-1700
Practice Address - Country:US
Practice Address - Phone:202-963-0771
Practice Address - Fax:202-886-1203
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker