Provider Demographics
NPI:1588443048
Name:ELDRIDGE, ALICIA M (MSW INTERN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-7241
Mailing Address - Country:US
Mailing Address - Phone:843-661-2135
Mailing Address - Fax:
Practice Address - Street 1:1435 DEBERRY BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5601
Practice Address - Country:US
Practice Address - Phone:843-407-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical