Provider Demographics
NPI:1326343633
Name:WILLIAMS, BRIDGET M (LP)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 WEATHERLY DRIVE
Mailing Address - Street 2:F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043
Mailing Address - Country:US
Mailing Address - Phone:773-558-2146
Mailing Address - Fax:
Practice Address - Street 1:775 WEATHERLY DRIVE
Practice Address - Street 2:F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:773-558-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2218101YP2500X
MD06007103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional