Provider Demographics
NPI:1942401567
Name:ETHRIDGE, DAVID G (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:ETHRIDGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 AMSTERDAM CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3333
Mailing Address - Country:US
Mailing Address - Phone:912-355-8215
Mailing Address - Fax:
Practice Address - Street 1:7505 WATERS AVE
Practice Address - Street 2:SUITE E2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3821
Practice Address - Country:US
Practice Address - Phone:912-356-2328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional