Provider Demographics
NPI:1053657742
Name:DICKSON, BRIDGET BAKER (LAC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:BAKER
Last Name:DICKSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 FLORIDA AVE SW
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4635
Mailing Address - Country:US
Mailing Address - Phone:225-281-8115
Mailing Address - Fax:225-243-6029
Practice Address - Street 1:1295 FLORIDA AVE SW
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4635
Practice Address - Country:US
Practice Address - Phone:225-281-8115
Practice Address - Fax:225-243-6029
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA681101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)