Provider Demographics
NPI:1427697788
Name:BRIDGENS, KRISTINA ANN (CDCA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:BRIDGENS
Suffix:
Gender:
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 YOUNGSTOWN RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-5002
Mailing Address - Country:US
Mailing Address - Phone:330-369-8022
Mailing Address - Fax:
Practice Address - Street 1:2737 YOUNGSTOWN RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-5002
Practice Address - Country:US
Practice Address - Phone:330-369-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002181175T00000X
OH177400324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No175T00000XOther Service ProvidersPeer Specialist