Provider Demographics
NPI:1639227051
Name:RIDLEHOOVER, SONJA NORRIS (LMFT)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:NORRIS
Last Name:RIDLEHOOVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2871
Mailing Address - Country:US
Mailing Address - Phone:478-746-2333
Mailing Address - Fax:478-746-2380
Practice Address - Street 1:146 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-2871
Practice Address - Country:US
Practice Address - Phone:478-746-2333
Practice Address - Fax:478-746-2380
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA839672917AMedicaid