Basic Information
| Provider Information | |||||||||
| NPI: | 1710649645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIDGES | ||||||||
| FirstName: | LATONYA | ||||||||
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| Credential: | LCSW-A, LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 753 | ||||||||
| Address2: | |||||||||
| City: | COATS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275210753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197718900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 609 ATTAIN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | FUQUAY VARINA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275261984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195670684 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2021 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P016816 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.