Provider Demographics
NPI:1861640583
Name:RIDDLE, JANEL M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANEL
Middle Name:M
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINCKNEY BOULEVARD
Mailing Address - Street 2:BOX 6266A
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-0000
Mailing Address - Country:US
Mailing Address - Phone:843-228-5599
Mailing Address - Fax:843-228-5682
Practice Address - Street 1:1 PINCKNEY BLVD
Practice Address - Street 2:BOX 6266A
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6122
Practice Address - Country:US
Practice Address - Phone:843-228-5599
Practice Address - Fax:843-228-5682
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical