Provider Demographics
NPI:1336372424
Name:BRIDGEMAN, PAMELA ANITA (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANITA
Last Name:BRIDGEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HENDERSON DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3744
Mailing Address - Country:US
Mailing Address - Phone:770-334-2493
Mailing Address - Fax:770-334-2675
Practice Address - Street 1:650 HENDERSON DR
Practice Address - Street 2:SUITE 430
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3744
Practice Address - Country:US
Practice Address - Phone:770-334-2493
Practice Address - Fax:770-334-2675
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004483101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW004483OtherMEDICARE PART B