Provider Demographics
NPI:1891099487
Name:KNOWLES, BRIDGET COMAN (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:COMAN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2051
Mailing Address - Country:US
Mailing Address - Phone:478-633-8100
Mailing Address - Fax:478-633-6268
Practice Address - Street 1:1014 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2051
Practice Address - Country:US
Practice Address - Phone:478-633-8100
Practice Address - Fax:478-633-6268
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist