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General NPI Number Information
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NPI Number | 1568290245
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Entity Type | Individual
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Provider Name | MEGAN CLAIRE WALLACE BRIDGES ALC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2024
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 1505 PELHAM RD S STE 7
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3707
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Country | US
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Telephone | 256-343-9717
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Fax |
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Provider Business Mailing Address
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Address Line | 507 ROY PARRIS ROAD
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City | JACKSONVILLE
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State | AL
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Zip | 36265-8105
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Country | US
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Telephone | 256-365-8668
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Fax | 256-241-4833
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | ALC04794
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License Number State | AL
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