Healthcare Provider Details

I. General information

NPI: 1396992509
Provider Name (Legal Business Name): DAVID EARL RIDLEY SC.D., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 WAIANUENUE AVE ROOM 202
HILO HI
96720
US

IV. Provider business mailing address

1787 HALEOKEA ST
HILO HI
96720-5946
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-4412
  • Fax: 808-969-9447
Mailing address:
  • Phone: 808-959-5911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMH 100
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: