Healthcare Provider Details

I. General information

NPI: 1073616678
Provider Name (Legal Business Name): BRIDGE COUNSELING AND THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 BRIDGEVILLE RD
GEORGETOWN DE
19947-2106
US

IV. Provider business mailing address

32 BRIDGEVILLE RD
GEORGETOWN DE
19947-2106
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-9190
  • Fax: 302-856-9133
Mailing address:
  • Phone: 302-856-9190
  • Fax: 302-856-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ100000281
License Number StateDE

VIII. Authorized Official

Name: MS. JOEL A VANINI
Title or Position: DIRECTOR
Credential: LCSW
Phone: 302-856-9190