Provider Demographics
NPI:1912675968
Name:CARTER, BRIDGETTE MICHELLE
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:MICHELLE
Last Name:CARTER
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 1:1626 AZALEA AVE
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081-5806
Mailing Address - Country:US
Mailing Address - Phone:704-298-9260
Mailing Address - Fax:
Practice Address - Street 1:8440 PIT STOP CT NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8245
Practice Address - Country:US
Practice Address - Phone:704-960-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician