Provider Demographics
NPI:1083163752
Name:THE RIDGE
Entity Type:Organization
Organization Name:THE RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUGUSTINO-WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PHD, CCJP
Authorized Official - Phone:615-985-2424
Mailing Address - Street 1:514 HILL STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172
Mailing Address - Country:US
Mailing Address - Phone:615-985-2424
Mailing Address - Fax:615-645-7333
Practice Address - Street 1:514 HILL STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-985-2424
Practice Address - Fax:615-645-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1509101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty