Provider Demographics
NPI:1972952620
Name:RIDDLE, NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W CENTER ST
Mailing Address - Street 2:STE 205
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-3742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 W CENTER ST STE 205
Practice Address - Street 2:STE 205
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3741
Practice Address - Country:US
Practice Address - Phone:740-341-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1600205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional