Provider Demographics
NPI:1609375351
Name:RAGSDALE, ICIA (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:ICIA
Middle Name:
Last Name:RAGSDALE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2870
Mailing Address - Country:US
Mailing Address - Phone:443-744-2777
Mailing Address - Fax:
Practice Address - Street 1:3135 RIPPLE RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2870
Practice Address - Country:US
Practice Address - Phone:443-744-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health