Healthcare Provider Details

I. General information

NPI: 1093653255
Provider Name (Legal Business Name): HER BRIDGE COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 E COUNTY LINE RD
JACKSON MS
39211-1806
US

IV. Provider business mailing address

514 CASTLEWOODS BLVD
BRANDON MS
39047-7632
US

V. Phone/Fax

Practice location:
  • Phone: 769-229-2413
  • Fax:
Mailing address:
  • Phone: 769-229-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: DEMEARA VIRGIL
Title or Position: EXECUTIVE DIRECTOR
Credential: BS PSYCHOLOGY DEGREE
Phone: 769-229-2413