Individual
AMY RIDLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADTP
Contact information
Practice address
98 HENDLEY ST, SANTA ROSA, CA 95404-5025
(707) 527-0412
Mailing address
98 HENDLEY ST, SANTA ROSA, CA 95404-5025
(707) 527-0412
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
490004EN
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8658
—
CA
Enumeration date
08/15/2019
Last updated
08/15/2019
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