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General NPI Number Information
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NPI Number | 1003372905
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Entity Type | Individual
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Provider Name | ANDRE RIDDICK SR. LPCC
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Gender | Male
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 1301 WINCHESTER RD STE 147
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City | LEXINGTON
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State | KY
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Zip | 40505-4179
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Country | US
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Telephone | 859-991-0710
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Fax | 859-309-1791
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Provider Business Mailing Address
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Address Line | 1301 WINCHESTER RD STE 147
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City | LEXINGTON
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State | KY
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Zip | 40505-4179
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Country | US
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Telephone | 859-991-0710
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Fax | 859-309-1791
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 288964
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License Number State | KY
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