Provider Demographics
NPI:1619464906
Name:BALDRIGE, COLLEEN CLARA (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CLARA
Last Name:BALDRIGE
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 1:6047 TYVOLA GLEN CIR # 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-6431
Mailing Address - Country:US
Mailing Address - Phone:980-320-0528
Mailing Address - Fax:
Practice Address - Street 1:6047 TYVOLA GLEN CIR # 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-6431
Practice Address - Country:US
Practice Address - Phone:980-320-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0110391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical