Provider Demographics
NPI:1215538970
Name:BRIDGES, CAROLINE (BCABA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:FARGERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1823
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-1823
Mailing Address - Country:US
Mailing Address - Phone:318-588-8908
Mailing Address - Fax:
Practice Address - Street 1:4440 VIKING DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7511
Practice Address - Country:US
Practice Address - Phone:318-588-8908
Practice Address - Fax:318-588-8909
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAC-065106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC-065OtherSTATE CERTIFIED ASSISTANT BEHAVOIR ANALYST