Provider Demographics
NPI:1568923324
Name:RITCH, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RITCH
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 1:109 NATURE WALK PKWY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5065
Mailing Address - Country:US
Mailing Address - Phone:904-710-7586
Mailing Address - Fax:
Practice Address - Street 1:109 NATURE WALK PKWY UNIT 104
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5065
Practice Address - Country:US
Practice Address - Phone:904-710-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health