Healthcare Provider Details

I. General information

NPI: 1639208705
Provider Name (Legal Business Name): BRIDGETTE CHASE LPC, CAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRIDGETTE LAVETTE WHITE LPC, CAC

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N GLEBE RD STE 525
ARLINGTON VA
22201-5792
US

IV. Provider business mailing address

1820 IRVING ST NE APT 105
WASHINGTON DC
20018-2445
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 202-635-8078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC 890
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012647
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: