Provider Demographics
NPI:1477764041
Name:BRIDGFORTH, MYRA BINNS (LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:MYRA
Middle Name:BINNS
Last Name:BRIDGFORTH
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 MAPLE AVE W STE 2
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4229
Mailing Address - Country:US
Mailing Address - Phone:703-281-4703
Mailing Address - Fax:
Practice Address - Street 1:513 MAPLE AVE W STE 2
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4229
Practice Address - Country:US
Practice Address - Phone:703-281-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000531106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist