Provider Demographics
NPI:1669536223
Name:RIDDICK, JOYCE (LPC)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:RIDDICK
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 1:614 S FANCHER ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2619
Mailing Address - Country:US
Mailing Address - Phone:989-773-9382
Mailing Address - Fax:989-773-9803
Practice Address - Street 1:118 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2513
Practice Address - Country:US
Practice Address - Phone:989-773-9328
Practice Address - Fax:989-773-1903
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health