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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