Provider Demographics
NPI:1366291965
Name:PRIDGEN, CAROLINE DELORES (LCSWA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:DELORES
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 PARK RD STE 320
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3790
Mailing Address - Country:US
Mailing Address - Phone:704-577-4071
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:10706 SIKES PL STE 275
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8015
Practice Address - Country:US
Practice Address - Phone:704-577-4071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
NCP0225341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician