Provider Demographics
NPI:1457687477
Name:HICKS, BRIDGET DANIELLE (MS LMFT)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:DANIELLE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:DANIELLE
Other - Last Name:POLLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:POLLACK-NABER
Mailing Address - Street 1:11346 RUSTIC PINES CIR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-4501
Mailing Address - Country:US
Mailing Address - Phone:904-479-8566
Mailing Address - Fax:
Practice Address - Street 1:11346 RUSTIC PINES CIR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-4501
Practice Address - Country:US
Practice Address - Phone:904-479-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3310106H00000X
MN1794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist