Provider Demographics
NPI:1689983629
Name:KING, BRIDGETTE MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 MILGEN RD
Mailing Address - Street 2:APARTMENT 1364
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5889
Mailing Address - Country:US
Mailing Address - Phone:678-340-5672
Mailing Address - Fax:
Practice Address - Street 1:6300 MILGEN RD
Practice Address - Street 2:APARTMENT 1364
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5889
Practice Address - Country:US
Practice Address - Phone:678-340-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional