Provider Demographics
NPI:1346553930
Name:COSSEY, BRIDGETTE NICOLE (LSW)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:NICOLE
Last Name:COSSEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 STONE ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4523
Mailing Address - Country:US
Mailing Address - Phone:870-932-6505
Mailing Address - Fax:
Practice Address - Street 1:1600 ALDERSGATE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6614
Practice Address - Country:US
Practice Address - Phone:501-661-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2698-B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker