Provider Demographics
NPI:1649952896
Name:BRIDGES, ALEXIS
Entity type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MARDEN CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4338
Mailing Address - Country:US
Mailing Address - Phone:256-457-1685
Mailing Address - Fax:
Practice Address - Street 1:3379 HIGHWAY 5 STE F
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2377
Practice Address - Country:US
Practice Address - Phone:470-299-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACGS1606101YS0200X
GATDU3580347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool