Provider Demographics
NPI:1710649645
Name:RIDGES, LATONYA (LCSW-A, LCAS)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:
Last Name:RIDGES
Suffix:
Gender:F
Credentials:LCSW-A, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0753
Mailing Address - Country:US
Mailing Address - Phone:919-771-8900
Mailing Address - Fax:
Practice Address - Street 1:609 ATTAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1984
Practice Address - Country:US
Practice Address - Phone:919-567-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0168161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical