Provider Demographics
NPI:1427085307
Name:BRIDGES, LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-417-0104
Mailing Address - Fax:919-556-1568
Practice Address - Street 1:500 WAIT AVE
Practice Address - Street 2:STE 2
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2779
Practice Address - Country:US
Practice Address - Phone:919-417-0104
Practice Address - Fax:919-556-1568
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134VEOtherBCBS
NC6002621Medicaid
NC6002621Medicaid