Provider Demographics
NPI:1609501782
Name:CHANDLER, BRIDGET RENEE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:RENEE
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 NASH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-8431
Mailing Address - Country:US
Mailing Address - Phone:910-551-0720
Mailing Address - Fax:
Practice Address - Street 1:351 WAGONER DR STE 175
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4860
Practice Address - Country:US
Practice Address - Phone:919-790-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health