Provider Demographics
NPI:1962095539
Name:RIDGES, BREANA (LCMHC, NCC, CFMHE)
Entity type:Individual
Prefix:MRS
First Name:BREANA
Middle Name:
Last Name:RIDGES
Suffix:
Gender:F
Credentials:LCMHC, NCC, CFMHE
Other - Prefix:
Other - First Name:BREANA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC, NCC, CFMHE
Mailing Address - Street 1:PO BOX 2382
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-2382
Mailing Address - Country:US
Mailing Address - Phone:910-556-9075
Mailing Address - Fax:
Practice Address - Street 1:1330 SE MAYNARD RD STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3628
Practice Address - Country:US
Practice Address - Phone:910-556-9075
Practice Address - Fax:919-367-1921
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health