Basic Information
| Provider Information | |||||||||
| NPI: | 1720280126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALDRIDGE | ||||||||
| FirstName: | RONDA | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 RAULSTON DR | ||||||||
| Address2: | |||||||||
| City: | BYRAM | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392729243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013730311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1547 JERRY CLOWER BLVD | ||||||||
| Address2: | |||||||||
| City: | YAZOO CITY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391942718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6627466532 | ||||||||
| FaxNumber: | 6627467143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C4656 | MS | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 00682563 | 05 | MS | MEDICAID |