Provider Demographics
NPI:1598101446
Name:COLEMAN, BRIDGETT (LPC)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MANDARIN DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-6300
Mailing Address - Country:US
Mailing Address - Phone:912-432-6264
Mailing Address - Fax:
Practice Address - Street 1:213 N MCDONALD ST STE A&B
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-6075
Practice Address - Country:US
Practice Address - Phone:912-545-9398
Practice Address - Fax:912-545-2747
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional