Healthcare Provider Details

I. General information

NPI: 1174591044
Provider Name (Legal Business Name): DEBORRA CASSANDRA RIKARD NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 ROAD 1203
NETTLETON MS
38858-8283
US

IV. Provider business mailing address

432 ROAD 1203
NETTLETON MS
38858-8283
US

V. Phone/Fax

Practice location:
  • Phone: 662-419-4495
  • Fax:
Mailing address:
  • Phone: 662-419-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3215
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: