Individual
AMANDA MARIE RIDGELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
720 COLISEUM DR STE 92, WINSTON SALEM, NC 27106-5357
(743) 255-4568
Mailing address
720 COLISEUM DR STE 92, WINSTON SALEM, NC 27106-5357
(743) 255-4568
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301017265
MI
103TC0700X
Clinical Psychologist
6362007710
MI
106S00000X
Behavior Technician
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
OH
172V00000X
Community Health Worker
—
OH
Other
Enumeration date
11/10/2017
Last updated
10/18/2024
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