Basic Information
| Provider Information | |||||||||
| NPI: | 1578142634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALDRIDGE | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | LORRAINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | BACHLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 N ARROWHEAD AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924011148 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 N ARROWHEAD AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924011148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095224656 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2021 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 251885 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.