Provider Demographics
NPI:1164402467
Name:ELDRIDGE, GUY L (CSC-AD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:L
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEALTH CARE FOR THE HOMELESS
Mailing Address - Street 2:111 PARK AVE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-837-5533
Mailing Address - Fax:410-837-8020
Practice Address - Street 1:HEALTH CARE FOR THE HOMELESS
Practice Address - Street 2:111 PARK AVE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-837-4292
Practice Address - Fax:410-837-8020
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC1224101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor