Provider Demographics
NPI:1760808570
Name:BRIDGES, MARY MYERS (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MYERS
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY MOLLY
Other - Middle Name:
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 2487
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-8009
Mailing Address - Country:US
Mailing Address - Phone:912-655-2323
Mailing Address - Fax:
Practice Address - Street 1:911 LYTTLETON ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4412
Practice Address - Country:US
Practice Address - Phone:803-713-7979
Practice Address - Fax:803-728-2200
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6409101YA0400X, 101YM0800X, 101YP2500X
LPC008437101YM0800X
GALPC008437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health