Provider Demographics
NPI:1467197871
Name:RIDDICK, RENITA LYNN (LMSW)
Entity type:Individual
Prefix:MS
First Name:RENITA
Middle Name:LYNN
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:LMSW
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 219
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-0219
Mailing Address - Country:US
Mailing Address - Phone:202-618-1084
Mailing Address - Fax:
Practice Address - Street 1:100 CENTENNIAL ST
Practice Address - Street 2:#219
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-0219
Practice Address - Country:US
Practice Address - Phone:202-618-1084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker