Provider Demographics
NPI:1003880931
Name:RIDGWAY, CONSTANCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S WHITING ST STE 605
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7121
Mailing Address - Country:US
Mailing Address - Phone:202-966-8230
Mailing Address - Fax:202-966-8230
Practice Address - Street 1:205 S WHITING ST STE 605
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7121
Practice Address - Country:US
Practice Address - Phone:202-966-8230
Practice Address - Fax:202-966-8230
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040031341041C0700X
DCLC3027351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1764OtherCAREFIRST BC/BS #
VA120224OtherVALUE OPTIONS PROVIDER #
VA120224OtherVALUE OPTIONS PROVIDER #