Healthcare Provider Details

I. General information

NPI: 1376140681
Provider Name (Legal Business Name): ANGELIQUE BRIDGES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DUKE ST UNIT 106
PRINCE FREDERICK MD
20678-7505
US

IV. Provider business mailing address

65 DUKE ST STE 106
PRINCE FREDERICK MD
20678-6128
US

V. Phone/Fax

Practice location:
  • Phone: 443-295-8955
  • Fax:
Mailing address:
  • Phone: 270-681-7876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number174757
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM846
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC11972
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: