Provider Demographics
NPI:1295445492
Name:BRIDGES, JULIA (LCAS-A)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PINEHURST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7099
Mailing Address - Country:US
Mailing Address - Phone:910-725-1246
Mailing Address - Fax:
Practice Address - Street 1:139 PINEHURST AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7099
Practice Address - Country:US
Practice Address - Phone:910-725-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)