| Doctor Name: | RITCHIE PUCKETT |
| NPI Number: | 1093198954 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCAS-A |
| License Number: | LCAS 21887 |
| Business Practice Address: | 847 W Lake Dr Mount Airy, NC - 270302157 |
| Business Phone Number: | 3367836919 |
| Business Fax Number: | |
| Mailing Address: | 284 Executive Park Dr. Suite 100, CONCORD |
| State: | NC |
| Postal Code: | 280251894 |
| Phone Number: | 7049391100 |
| Fax Number: | 7049391173 |
| NPI Enumeration Date: | 07/09/2015 |
| NPI Last Update Date: | 07/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCAS 21887 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |