Active NPI
Amanda Marie Ridgeley
- Behavior Technician
- Winston Salem, NC
National Provider Identifier
1619480712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 720 Coliseum Dr Ste 92
Winston Salem, NC 27106-5357 - Phone
- (743) 255-4568
- NPI assigned
- Nov 10, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6362007710 | MI | |
| Case Manager/Care Coordinator | 171M00000X | OH | ||
| Community Health Worker | 172V00000X | OH | ||
| Behavior Technician | 106S00000X | Primary | ||
| Clinical Psychologist | 103TC0700X | 6301017265 | MI |
Addresses
Primary practice location
720 Coliseum Dr Ste 92
Winston Salem, NC 27106-5357
Mailing address
720 Coliseum Dr Ste 92
Winston Salem, NC 27106-5357
Phone (743) 255-4568
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301017265 | MI | MD | Clinical Psychologist |
| 6362007710 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729209600000",
"number": "1619480712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 COLISEUM DR STE 92",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271065357",
"telephone_number": "743-255-4568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 COLISEUM DR STE 92",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271065357",
"telephone_number": "743-255-4568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDGELEY",
"first_name": "AMANDA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-10",
"last_updated": "2024-10-18",
"certification_date": "2024-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6362007710",
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "OH",
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301017265",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.