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NPI 1639128747

NPI 1639128747 : BRIDGET ANN GWINNETT M.S., LPC, NCC : GREENSBORO, NC

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General NPI Number Information
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    NPI Number           |    1639128747
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    Entity Type          |    Individual 
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    Provider Name        |    BRIDGET ANN GWINNETT M.S., LPC, NCC
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    05/08/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    2307 W CONE BLVD SUITE 130
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    City                 |    GREENSBORO
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    State                |    NC
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    Zip                  |    27408-4027
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    Country              |    US
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    Telephone            |    336-339-5530
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    Fax                  |    336-545-8749
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Provider Business Mailing Address
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    Address Line         |    102 FREDERICK RD 
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    City                 |    GREENSBORO
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    State                |    NC
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    Zip                  |    27455-1707
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    Country              |    US
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    Telephone            |    336-339-5530
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    Fax                  |    336-545-8749
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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       |    LPC 3017
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    License Number State |    NC
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