Provider Demographics
NPI:1629124581
Name:RIDGEWAY, PATRICIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:RIDGEWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-0307
Mailing Address - Country:US
Mailing Address - Phone:336-789-1693
Mailing Address - Fax:
Practice Address - Street 1:203 E LEBANON ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3663
Practice Address - Country:US
Practice Address - Phone:336-789-1693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical