Basic Information
| Provider Information | |||||||||
| NPI: | 1053894709 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURBIN | ||||||||
| FirstName: | BRIDGETTE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 BEDFORD ST | ||||||||
| Address2: | |||||||||
| City: | HOLLIDAYSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166481713 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 LAKEMONT PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166025967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149460261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 09/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.