Provider Demographics
NPI:1154387470
Name:RICKENBAKER, PATRICIA S (LISW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:RICKENBAKER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7503
Mailing Address - Country:US
Mailing Address - Phone:919-539-9650
Mailing Address - Fax:919-787-6470
Practice Address - Street 1:4601 LAKE BOONE TRL
Practice Address - Street 2:SUITE 2-C
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7503
Practice Address - Country:US
Practice Address - Phone:919-539-9650
Practice Address - Fax:919-787-6470
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0024201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical