Provider Demographics
NPI:1447708706
Name:AUGUSTINO-WILKE, BRIDGETT L (MA, PHD, CCJP)
Entity type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:L
Last Name:AUGUSTINO-WILKE
Suffix:
Gender:F
Credentials:MA, PHD, CCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 HILL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2902
Mailing Address - Country:US
Mailing Address - Phone:615-985-2424
Mailing Address - Fax:615-645-7333
Practice Address - Street 1:514 HILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2902
Practice Address - Country:US
Practice Address - Phone:615-985-2424
Practice Address - Fax:615-645-7333
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1509101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)