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General NPI Number Information
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NPI Number | 1336372424
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Entity Type | Individual
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Provider Name | PAMELA ANITA BRIDGEMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 650 HENDERSON DR SUITE 430
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3744
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Country | US
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Telephone | 770-334-2493
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Fax | 770-334-2675
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Provider Business Mailing Address
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Address Line | 650 HENDERSON DR SUITE 430
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3744
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Country | US
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Telephone | 770-334-2493
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Fax | 770-334-2675
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CSW004483
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004483
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License Number State | GA
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