Healthcare Provider Details

I. General information

NPI: 1467082651
Provider Name (Legal Business Name): THE B.R.I.D.G.E COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 TALIAFERRO TRL
MONTGOMERY AL
36117-7758
US

IV. Provider business mailing address

1775 TALIAFERRO TRL
MONTGOMERY AL
36117-7758
US

V. Phone/Fax

Practice location:
  • Phone: 334-245-3361
  • Fax:
Mailing address:
  • Phone: 334-245-3361
  • Fax: 334-239-7716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAQUANDA WIGGINS
Title or Position: OWNER/THERAPIST
Credential: CCTP, NCC, LPC
Phone: 334-245-3361