Provider Demographics
NPI:1639128747
Name:GWINNETT, BRIDGET ANN (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ANN
Last Name:GWINNETT
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1707
Mailing Address - Country:US
Mailing Address - Phone:336-339-5530
Mailing Address - Fax:336-545-8749
Practice Address - Street 1:2307 W CONE BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4027
Practice Address - Country:US
Practice Address - Phone:336-339-5530
Practice Address - Fax:336-545-8749
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 3017101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional