Individual
IVY PRIDGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 WASHINGTON BLVD, BALTIMORE, MD 21230-1824
(410) 467-6040
(410) 783-0569
Mailing address
PO BOX 33109, BALTIMORE, MD 21218-0401
(410) 467-6040
(410) 235-8807
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
SC1867
MD
Other
Enumeration date
05/08/2014
Last updated
05/08/2014
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