Provider Demographics
NPI:1710016472
Name:BRIDGES, JAMILAH INEZ
Entity type:Individual
Prefix:MISS
First Name:JAMILAH
Middle Name:INEZ
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 O ST
Mailing Address - Street 2:APARTMENT #A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5967
Mailing Address - Country:US
Mailing Address - Phone:916-719-6561
Mailing Address - Fax:
Practice Address - Street 1:7000 FRANKLIN BLVD
Practice Address - Street 2:STE. 1230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1820
Practice Address - Country:US
Practice Address - Phone:916-393-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor