Provider Demographics
NPI:1467914697
Name:ROYAL HOLLAND, BRIDGET M
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:ROYAL HOLLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 TOWNE PARK DR W
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5182
Mailing Address - Country:US
Mailing Address - Phone:912-657-4329
Mailing Address - Fax:
Practice Address - Street 1:613 TOWNE PARK DR W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5182
Practice Address - Country:US
Practice Address - Phone:912-657-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-15-01368106S00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician