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General NPI Number Information
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NPI Number | 1992478077
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Entity Type | Individual
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Provider Name | MRS. CHARMAINE BRIDGENS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1303 SAN CARLOS AVE
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City | SAN CARLOS
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State | CA
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Zip | 94070-2317
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Country | US
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Telephone | 650-394-5155
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Fax |
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Provider Business Mailing Address
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Address Line | 412 FORREST DR
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City | COLUMBIA
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State | TN
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Zip | 38401-6521
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Country | US
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Telephone | 714-316-2932
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APCC11820
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT134305
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License Number State | CA
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