Provider Demographics
NPI:1619322740
Name:BRIDGES, DANA (LMHC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6267 POTTSBURG PLANTATION BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8954
Mailing Address - Country:US
Mailing Address - Phone:904-334-9954
Mailing Address - Fax:
Practice Address - Street 1:6267 POTTSBURG PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8954
Practice Address - Country:US
Practice Address - Phone:904-334-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health