Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1035 | NC |
Y | 103TC0700X | Clinical Psychologist | 1035 | NC |
N | 103TH0100X | Health Service | 1035 | NC |
NPI | 1598923310 |
---|---|
Provider Name | Dr. Alec Riddle |
First Address | Hickory, NC 28602-5225 |
Second Address | Hickory, NC 28602-5225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 29/05/2008 |