Provider Demographics
NPI:1437379856
Name:PRIDE, AIMEE MARIE (MS, CRC, QRP)
Entity Type:Individual
Prefix:MS
First Name:AIMEE
Middle Name:MARIE
Last Name:PRIDE
Suffix:
Gender:F
Credentials:MS, CRC, QRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 GREENTREE VLG
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-9412
Mailing Address - Country:US
Mailing Address - Phone:304-377-0381
Mailing Address - Fax:304-534-3058
Practice Address - Street 1:22 GREENTREE VLG
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-9412
Practice Address - Country:US
Practice Address - Phone:304-377-0381
Practice Address - Fax:304-534-3058
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVQRP00000111171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQRP00000111OtherQUALIFIED REHABILITATION
ILC-034613OtherCRC