Provider Demographics
NPI:1609552256
Name:DONNELLY, BRIDGET CLARE
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:CLARE
Last Name:DONNELLY
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 1:712 DURANT PL NE APT 2
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-7001
Mailing Address - Country:US
Mailing Address - Phone:219-728-8644
Mailing Address - Fax:
Practice Address - Street 1:6065 ROSWELL RD STE 960
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4038
Practice Address - Country:US
Practice Address - Phone:404-919-7241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0106031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical