Individual
RICO D STREET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
2220 UNION AVE, MEMPHIS, TN 38104-4315
(901) 567-3554
Mailing address
2220 UNION AVE, MEMPHIS, TN 38104-4315
(901) 567-3554
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11552
TN
104100000X
Social Worker
M9136
MS
Other
Enumeration date
11/07/2017
Last updated
11/07/2017
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