Provider Demographics
NPI:1437518990
Name:BENNETT BRIDGERS-CARLOS
Entity Type:Organization
Organization Name:BENNETT BRIDGERS-CARLOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:BRIDGERS-CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:828-331-9928
Mailing Address - Street 1:111 PROCTORS HALL RD
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-2006
Mailing Address - Country:US
Mailing Address - Phone:828-331-9928
Mailing Address - Fax:931-933-7766
Practice Address - Street 1:91 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2265
Practice Address - Country:US
Practice Address - Phone:828-331-9928
Practice Address - Fax:931-933-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW59731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty