MEDICARE: KHADEESHA JACKE' RIDDICK MS

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
1	101YM0800X	Mental Health Counselor		NC

General Provider Information

NPI Number	:	1336942036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHADEESHA JACKE' RIDDICK MS

Provider Business Mailing Address
First Line	:	2418 S HOLDEN RD APT D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-5730
Country	:	US
Telephone Number	:	334-413-3447
Fax Number	:

Provider Business Practice Location Address
First Line	:	2418 S HOLDEN RD APT D
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-5730
Country	:	US
Telephone Number	:	334-413-3447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/03/2026

Similar Medicare Providers

1891640777 — KYMON NATONYA HEGGINS
Practice Location Address:

319 S WESTGATE DR STE D
GREENSBORO, NC
27407-1632

Practice Phone: 866-700-1606
Practice Fax:

1801977467 — MRS. KELLY JEANNE POWERS M.S. CCC-SLP
Practice Location Address:

4007 WALDENBROOK RD
GREENSBORO, NC
27407-7741

Practice Phone: 336-991-2422
Practice Fax:

1629256185 — HOLLY ANN CLARK CADC
Practice Location Address:

4813 W MARKET ST
GREENSBORO, NC
27407-1403

Practice Phone: 833-510-4357
Practice Fax:

1184627614 — DR. SUSIE OZETTA TROXLER PH.D.
Practice Location Address:

3409 W WENDOVER AVE STE E
GREENSBORO, NC
27407-1579

Practice Phone: 336-324-1610
Practice Fax:

1669476453 — SOUTHEASTERN RADIOLOGY PA
Practice Location Address:

3801 W MARKET ST
GREENSBORO, NC
27407-1301

Practice Phone: 336-852-3300
Practice Fax: 336-852-0651

1912901687 — DR. CHERYL A VIGLIONE MD
Practice Location Address:

3801 W MARKET ST
GREENSBORO, NC
27407-1301

Practice Phone: 336-852-3300
Practice Fax: 336-852-0651

Directions to “ KHADEESHA JACKE' RIDDICK MS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.