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NPI Code Detail

MEDICARE: MS. CORTEASIA RIDDICK MSW, LCSWA

MEDICARE: MS. CORTEASIA RIDDICK MSW, LCSWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1205335775
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CORTEASIA RIDDICK MSW, LCSWA
Provider Business Mailing Address
First Line : 5810 HORSE PASTURE LN APT 104
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-3276
Country : US
Telephone Number : 704-369-1078
Fax Number :
Provider Business Practice Location Address
First Line : 10130 MALLARD CREEK RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28262-6001
Country : US
Telephone Number : 704-944-3557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2018
Last Update Date : 02/04/2026

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