Individual ProviderLeah Tishelle BridgesCounselorBehavioral Health & Social Service ProvidersPractice Address1205 Dover Pl SE, Conyers, GA 30013-4621(404) 626-4801PECOS EnrollmentBased on the most recent information from CMS, provider Leah Tishelle Bridges does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 11:51 AM.Profile DetailsProvider ID1457136616Provider TypeIndividualFull NameBridges, Leah TishelleCredentialLAPCGenderFemaleSole ProprietorYesEnumeration Date8/28/2023Last Updated9/5/2023Contact InformationPractice LocationPractice Address1205 Dover Pl SE, Conyers, GA 30013-4621Phone(404) 626-4801FaxUnlisted FaxMailing LocationMailing Address1205 Dover Pl SE, Conyers, GA 30013-4621Phone(404) 626-4801FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseAPC009173GeorgiaCode101YM0800XDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseAPC009173Georgia