Provider Demographics
NPI:1134772684
Name:RIDGE, LAUREN CLARISE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CLARISE
Last Name:RIDGE
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 1:8820 SWEET GUM PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1236
Mailing Address - Country:US
Mailing Address - Phone:732-267-7176
Mailing Address - Fax:
Practice Address - Street 1:44790 MAYNARD SQ STE 130
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6514
Practice Address - Country:US
Practice Address - Phone:703-542-3737
Practice Address - Fax:703-584-7378
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040082861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical