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General NPI Number Information
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NPI Number | 1578299285
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Entity Type | Individual
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Provider Name | JESSICA L BRIDGES LPCA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 2 WHITSETT ST
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City | GREENVILLE
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State | SC
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Zip | 29601-3137
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Country | US
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Telephone | 864-630-1594
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Fax |
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Provider Business Mailing Address
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Address Line | 211 N ORCHARD FARMS AVE
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4868
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Country | US
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Telephone | 864-901-8845
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Fax | 864-406-6041
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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 | 10011
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License Number State | SC
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