Provider Demographics
NPI:1669467650
Name:ATCHLEY, BRIDGET (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:ATCHLEY
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2917
Mailing Address - Country:US
Mailing Address - Phone:910-457-5940
Mailing Address - Fax:910-457-4379
Practice Address - Street 1:5003 OQUINN BLVD SE STE B
Practice Address - Street 2:SOUTH HARBOUR VILLAGE
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-7431
Practice Address - Country:US
Practice Address - Phone:910-457-5940
Practice Address - Fax:910-457-4379
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104423Medicaid