Healthcare Provider Details

I. General information

NPI: 1790551315
Provider Name (Legal Business Name): ANITRA F BRIDGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

IV. Provider business mailing address

204 STERLING HILLS CIR
COLUMBIA SC
29229-7753
US

V. Phone/Fax

Practice location:
  • Phone: 877-315-8080
  • Fax:
Mailing address:
  • Phone: 803-265-0394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: