Provider Demographics
NPI:1689127185
Name:BRIDGES-JOHNSON, MILLICENT
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:
Last Name:BRIDGES-JOHNSON
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 1:905 PARKWOOD DR APT C
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5445
Mailing Address - Country:US
Mailing Address - Phone:318-789-2379
Mailing Address - Fax:
Practice Address - Street 1:905 PARKWOOD DR APT C
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5445
Practice Address - Country:US
Practice Address - Phone:318-789-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor