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General NPI Number Information
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NPI Number | 1083163752
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Entity Type | Organization
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Legal Business Name | THE RIDGE
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 514 HILL STREET
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City | SPRINGFIELD
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State | TN
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Zip | 37172
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Country | US
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Telephone | 615-985-2424
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Fax | 615-645-7333
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Provider Business Mailing Address
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Address Line | 514 HILL STREET
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City | SPRINGFIELD
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State | TN
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Zip | 37172
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Country | US
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Telephone | 615-985-2424
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Fax | 615-645-7333
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Authorized Official
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Title or Position | OWNER/EXECUTIVE DIRECTOR
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Name | BRIDGETT L AUGUSTINO-WILKE
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Credential | M.A., PHD, CCJP
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Telephone | 615-985-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1509
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License Number State | VA
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