Provider Demographics
NPI:1982688198
Name:PRIDDY, ANN S (LCSW LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:S
Last Name:PRIDDY
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 LEDO RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-1267
Mailing Address - Country:US
Mailing Address - Phone:229-483-5050
Mailing Address - Fax:229-485-1103
Practice Address - Street 1:2925 LEDO RD STE 1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1267
Practice Address - Country:US
Practice Address - Phone:229-483-5050
Practice Address - Fax:229-485-1103
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000257106H00000X
GA013371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
80BBC52Medicare ID - Type Unspecified