Provider Demographics
NPI:1831248574
Name:WILLIAMS, BRIDGETTE L (CADC1)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 BUSE ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3330
Mailing Address - Country:US
Mailing Address - Phone:503-650-2652
Mailing Address - Fax:
Practice Address - Street 1:1095 25TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5049
Practice Address - Country:US
Practice Address - Phone:503-399-7400
Practice Address - Fax:503-399-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06-11-68101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator