Provider Demographics
NPI:1528358975
Name:RIDDLE, AMANDA MICHELLE (CADC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:RIDDLE
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Gender:F
Credentials:CADC
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Mailing Address - Street 1:2153 E JOYCE BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4714
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:479-587-9392
Practice Address - Street 1:3715 N BUSINESS DR
Practice Address - Street 2:STE 104
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5204
Practice Address - Country:US
Practice Address - Phone:479-521-1532
Practice Address - Fax:479-521-9940
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2016-05-20
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR194359740Medicaid