Organization
GINGER RIDGE BEHAVIORAL HEALTH, LLC
Active
Organization
GINGER RIDGE BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLAUDETTE IDIGO L.C.S.W, (CLINICAL SOCIAL WORKER)
(678) 428-1728
Entity
Organization
Contact information
Practice address
170 BASTILLE WAY STE C, FAYETTEVILLE, GA 30214-7652
(770) 461-7010
(770) 461-7100
Mailing address
170 BASTILLE WAY STE C, FAYETTEVILLE, GA 30214-7652
(770) 461-7010
(770) 461-7100
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
CSW004018
GA
251S00000X
Community/Behavioral Health Agency
CSW004018
GA
261QD1600X
Developmental Disabilities Clinic/Center
CSW004018
GA
261QM0850X
Adult Mental Health Clinic/Center
Primary
CSW004018
GA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
CSW004018
GA
Other
Enumeration date
10/17/2011
Last updated
01/24/2012
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