Provider Demographics
NPI:1336911106
Name:WILLIAMS, BRIDGETTE C (LPC, LSATP)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:CARLETTE
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1207 BELL TOWER ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-3176
Mailing Address - Country:US
Mailing Address - Phone:757-739-9226
Mailing Address - Fax:
Practice Address - Street 1:1207 BELL TOWER ARCH
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-3176
Practice Address - Country:US
Practice Address - Phone:757-739-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012859101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional