| Doctor Name: | MISS MARY ELIZABETH RIDDICK |
| NPI Number: | 1144562166 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, L.P.C |
| License Number: | 760 |
| Business Practice Address: | 230 E Marydale Ave Suite 2 Soldotna, AK - 996697648 |
| Business Phone Number: | 9072603691 |
| Business Fax Number: | 9072603697 |
| Mailing Address: | 4511 Folker St Apt 39a, ANCHORAGE |
| State: | AK |
| Postal Code: | 995075206 |
| Phone Number: | 9074448355 |
| Fax Number: | |
| NPI Enumeration Date: | 03/18/2013 |
| NPI Last Update Date: | 03/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 760 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |