MEDICARE: HER BRIDGE COLLECTIVE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1093653255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HER BRIDGE COLLECTIVE

Provider Business Mailing Address
First Line	:	514 CASTLEWOODS BLVD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-7632
Country	:	US
Telephone Number	:	769-229-2413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1553 E COUNTY LINE RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-1806
Country	:	US
Telephone Number	:	769-229-2413
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DEMEARA VIRGIL
Credential	:	BS PSYCHOLOGY DEGREE
Telephone Number	:	769-229-2413

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “HER BRIDGE COLLECTIVE ” Practice Location

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