Provider Demographics
NPI:1336291079
Name:WRIGHT-RIDDELL, CHERYL LYNN (MA)
Entity Type:Individual
Prefix:MR
First Name:CHERYL
Middle Name:LYNN
Last Name:WRIGHT-RIDDELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHER
Other - Middle Name:LYNN
Other - Last Name:WRIGHT-RIDDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:405 MOUNTAIN CREEK TRCE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3523
Mailing Address - Country:US
Mailing Address - Phone:404-250-1267
Mailing Address - Fax:404-255-0268
Practice Address - Street 1:4501 CIRCLE 75 PKWY SE
Practice Address - Street 2:SUITE 5220E
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3025
Practice Address - Country:US
Practice Address - Phone:404-291-1998
Practice Address - Fax:404-255-0268
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001906101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health