Provider Demographics
NPI:1265776876
Name:MILLIKEN, BRIDGET DIXON (LCMHC, LCASA)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:DIXON
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:LCMHC, LCASA
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:DIXON
Other - Last Name:MILLIKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N FRONT ST STE 704
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5090
Mailing Address - Country:US
Mailing Address - Phone:910-769-9126
Mailing Address - Fax:910-769-9169
Practice Address - Street 1:201 N FRONT ST STE 704
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5090
Practice Address - Country:US
Practice Address - Phone:910-769-9126
Practice Address - Fax:910-769-9169
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20956101YA0400X
NC9796101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27730Medicaid