Individual
MIKA DE RIDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
427 W. LAWRENCE HARRIS HWY 52, SLOCOMB, AL 36375
(334) 618-3302
Mailing address
427 W. LAWRENCE HARRIS HWY 52, SLOCOMB, AL 36375
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
20-109628
AL
Other
Enumeration date
11/19/2025
Last updated
11/19/2025
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