Bridgett Princess Wiley

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

6639 Southpoint Pkwy Ste 108
Jacksonville, FL 32216-8042

Phone

(904) 438-7640

Fax

(904) 438-7656

NPI assigned

May 16, 2022

Last updated

May 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1336886027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "488 SKATE RD",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322333822",
            "telephone_number": "904-535-4154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6639 SOUTHPOINT PKWY STE 108",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168042",
            "telephone_number": "904-438-7640",
            "fax_number": "904-438-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "BRIDGETT",
        "middle_name": "PRINCESS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bridgett.wiley@ctcprograms.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF",
            "address_1": "6639 Southpoint Pkwy Ste 108",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322168042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wildly Authentic Counseling, LLC
• Wiles & Associates 6970 PA
• Alexandra Wiles, MS CCC-SLP
• Wiley Retirement Home (sanjuan retirement home)
• Amy L Wiley, M.S., CCC-SLP
• Carolyn Wiley
• Christie Lynne Wiley
• Kelvin James Wiley, M.D.
• Latasha Wiley
• Shelly Lynn Wiley, PTA

• Addiction (Substance Use Disorder) Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Addiction (Substance Use Disorder) Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.