=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063740181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LULA BRIDGES LBSW, SAP, CCAP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2009
-----------------------------------------------------
Last Update Date | 12/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 366 E MAIN ST
-----------------------------------------------------
City | NOTASULGA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36866-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-318-5108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 366 E MAIN ST
-----------------------------------------------------
City | NOTASULGA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36866-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-318-5108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2191B
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------