Provider Demographics
NPI:1568290245
Name:BRIDGES, MEGAN CLAIRE WALLACE (ALC)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:CLAIRE WALLACE
Last Name:BRIDGES
Suffix:
Gender:
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:507 ROY PARRIS ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-8105
Mailing Address - Country:US
Mailing Address - Phone:256-365-8668
Mailing Address - Fax:256-241-4833
Practice Address - Street 1:1505 PELHAM RD S STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3707
Practice Address - Country:US
Practice Address - Phone:256-343-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional