Provider Demographics
NPI:1649684176
Name:RODGERS, BRIDGETTE (MSPSYCH, BSW)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:RODGERS
Suffix:
Gender:F
Credentials:MSPSYCH, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3415
Mailing Address - Country:US
Mailing Address - Phone:843-401-0005
Mailing Address - Fax:843-401-0006
Practice Address - Street 1:209 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3415
Practice Address - Country:US
Practice Address - Phone:843-401-0005
Practice Address - Fax:843-401-0006
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor