Provider Demographics
NPI:1720280126
Name:ALDRIDGE, RONDA T (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:T
Last Name:ALDRIDGE
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 1:152 RAULSTON DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9243
Mailing Address - Country:US
Mailing Address - Phone:601-373-0311
Mailing Address - Fax:
Practice Address - Street 1:1547 JERRY CLOWER BLVD
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2718
Practice Address - Country:US
Practice Address - Phone:662-746-6532
Practice Address - Fax:662-746-7143
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC46561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00682563Medicaid