Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor |
NPI | 1205220464 |
---|---|
Provider Name | Jacqueline Bridges |
First Address | Memphis, TN 38104 |
Second Address | Memphis, TN 38104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 26/03/2015 |