Provider Demographics
NPI:1972191419
Name:BRIDGES, JOHANNA E (LPC, LCMHC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:E
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LPC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 W GATE CITY BLVD # K248
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7061
Mailing Address - Country:US
Mailing Address - Phone:484-716-2813
Mailing Address - Fax:
Practice Address - Street 1:5710 W GATE CITY BLVD # K248
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7061
Practice Address - Country:US
Practice Address - Phone:484-716-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00162200101YP2500X
NC15618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional