Healthcare Provider Details

I. General information

NPI: 1043611791
Provider Name (Legal Business Name): BRIDGET VACHA PH.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 METAIRIE RD # 8258
METAIRIE LA
70005-4034
US

IV. Provider business mailing address

406 BROCKENBRAUGH CT
METAIRIE LA
70005-3324
US

V. Phone/Fax

Practice location:
  • Phone: 504-952-2079
  • Fax:
Mailing address:
  • Phone: 504-952-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4664
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4664
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4664
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4664
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: