Provider Demographics
NPI:1295554392
Name:MCCONNELL, BRIDGET ANN (PCC)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 CULPEPPER ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-4105
Mailing Address - Country:US
Mailing Address - Phone:216-849-6113
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4283
Practice Address - Country:US
Practice Address - Phone:330-244-8795
Practice Address - Fax:330-244-8795
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0007210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health