Provider Demographics
NPI:1992865620
Name:PRIDGEN, DIANE ROKITA (ACSW,LCSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ROKITA
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:ACSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NORTH DOBBS STREET
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27839-0010
Mailing Address - Country:US
Mailing Address - Phone:252-583-5021
Mailing Address - Fax:
Practice Address - Street 1:19 NORTH DOBBS STREET
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:NC
Practice Address - Zip Code:27839-0010
Practice Address - Country:US
Practice Address - Phone:252-583-5021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional