| Doctor Name: | MS. AMY RICEDORF |
| NPI Number: | 1013283357 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NCC |
| License Number: | 255326 |
| Business Practice Address: | 4507 U S Highway 49 Hattiesburg, MS - 394019012 |
| Business Phone Number: | 6015452925 |
| Business Fax Number: | 6015452926 |
| Mailing Address: | Po Box 18679, HATTIESBURG |
| State: | MS |
| Postal Code: | 394048679 |
| Phone Number: | 6017051901 |
| Fax Number: | 6017051952 |
| NPI Enumeration Date: | 03/30/2012 |
| NPI Last Update Date: | 03/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 255326 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |