Provider Demographics
NPI:1639208705
Name:WHITE, BRIDGETTE LAVETTE (LPC, CAC)
Entity Type:Individual
Prefix:MS
First Name:BRIDGETTE
Middle Name:LAVETTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC, CAC
Other - Prefix:MS
Other - First Name:BRIDGETTE
Other - Middle Name:LAVETTEQ
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CAC
Mailing Address - Street 1:1820 IRVING ST NE APT 105
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2445
Mailing Address - Country:US
Mailing Address - Phone:202-635-8078
Mailing Address - Fax:
Practice Address - Street 1:1820 IRVING ST NE APT 105
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2445
Practice Address - Country:US
Practice Address - Phone:202-635-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC 890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional