Provider Demographics
NPI:1790033231
Name:GREEN, BRIDGET (NPC, LLPC)
Entity Type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:NPC, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 KENSINGTON DR
Mailing Address - Street 2:APT 259
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4065
Mailing Address - Country:US
Mailing Address - Phone:313-587-9963
Mailing Address - Fax:
Practice Address - Street 1:2387 WALTON BLVD
Practice Address - Street 2:EASTER SEALS
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326
Practice Address - Country:US
Practice Address - Phone:248-475-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health