Provider Demographics
NPI:1730311408
Name:COLE-BRIDGES, DWAN C (LPC-S)
Entity Type:Individual
Prefix:
First Name:DWAN
Middle Name:C
Last Name:COLE-BRIDGES
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-3658
Mailing Address - Country:US
Mailing Address - Phone:601-278-5569
Mailing Address - Fax:833-207-2223
Practice Address - Street 1:1549 W BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-3658
Practice Address - Country:US
Practice Address - Phone:601-278-5569
Practice Address - Fax:833-207-2223
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1458101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional