Provider Demographics
NPI:1265756167
Name:BAINBRIDGE, CANDI M (BA IN COMM DISORDERS)
Entity type:Individual
Prefix:
First Name:CANDI
Middle Name:M
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:BA IN COMM DISORDERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51234
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5534
Mailing Address - Country:US
Mailing Address - Phone:615-406-9416
Mailing Address - Fax:615-915-4756
Practice Address - Street 1:1344 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-6251
Practice Address - Country:US
Practice Address - Phone:615-406-9416
Practice Address - Fax:615-915-4756
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor