Provider Demographics
NPI:1861817496
Name:BRIDGES, LIDIANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LIDIANE
Middle Name:
Last Name:BRIDGES
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 1:15063 GAINES MILL CIR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2592
Mailing Address - Country:US
Mailing Address - Phone:901-825-7866
Mailing Address - Fax:
Practice Address - Street 1:15063 GAINES MILL CIR
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2592
Practice Address - Country:US
Practice Address - Phone:703-754-3914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional