Provider Demographics
NPI:1922124361
Name:RIDDLE, THOMAS EUGENE (CADC II)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EUGENE
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4856
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-4856
Mailing Address - Country:US
Mailing Address - Phone:530-823-8129
Mailing Address - Fax:
Practice Address - Street 1:145 BOST AVE
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3249
Practice Address - Country:US
Practice Address - Phone:530-265-9045
Practice Address - Fax:530-478-7977
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3735599101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)