Provider Demographics
NPI:1174936827
Name:RIDGWAY, MICHAEL WYNDHAM (LPCC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WYNDHAM
Last Name:RIDGWAY
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 E JAVA DR UNIT 62513
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94088-8026
Mailing Address - Country:US
Mailing Address - Phone:408-701-7722
Mailing Address - Fax:
Practice Address - Street 1:365 STOWELL AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4316
Practice Address - Country:US
Practice Address - Phone:408-829-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5977101YP2500X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist