Provider Demographics
NPI:1366745051
Name:PRIDGEN, GINA POWELL (MSW)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:POWELL
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 WINTER GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1631
Mailing Address - Country:US
Mailing Address - Phone:704-877-1920
Mailing Address - Fax:
Practice Address - Street 1:7011 WINTER GARDEN DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1631
Practice Address - Country:US
Practice Address - Phone:704-877-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-18
Last Update Date:2021-02-11
Deactivation Date:2014-09-18
Deactivation Code:
Reactivation Date:2021-02-11
Provider Licenses
StateLicense IDTaxonomies
NCA8474104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker