Provider Demographics
NPI:1659101426
Name:MATHWIN, BRIDGET ALVIS (LPC)
Entity type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:ALVIS
Last Name:MATHWIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:DENISE
Other - Last Name:ALVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 VILLAGE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-4112
Mailing Address - Country:US
Mailing Address - Phone:434-332-5149
Mailing Address - Fax:
Practice Address - Street 1:37 VILLAGE HWY STE 2
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588-4112
Practice Address - Country:US
Practice Address - Phone:434-332-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional