Provider Demographics
NPI:1396767703
Name:VIDAK, RIKKI A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RIKKI
Middle Name:A
Last Name:VIDAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 W HIGHWAY 98
Mailing Address - Street 2:CODE 37
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:850-505-6180
Mailing Address - Fax:850-505-6173
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:CODE 37
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0001
Practice Address - Country:US
Practice Address - Phone:850-505-6180
Practice Address - Fax:850-505-6173
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW27541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical