Provider Demographics
NPI:1356979926
Name:FLYNN, BRIDGET A (LMFT, ATR)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:A
Last Name:FLYNN
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8428 TERRITORY TRL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4434
Mailing Address - Country:US
Mailing Address - Phone:408-250-0854
Mailing Address - Fax:
Practice Address - Street 1:8428 TERRITORY TRL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4434
Practice Address - Country:US
Practice Address - Phone:408-250-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist