Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1043429350 |
---|---|
Provider Name | Mr. Nicholas Brandon Riddle |
First Address | Maumelle, AR 72113-7419 |
Second Address | Little Rock, AR 72210-5323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |