Healthcare Provider Details

I. General information

NPI: 1477436533
Provider Name (Legal Business Name): COMMUNITY BRIDGE COUNSELING AND OUTREACH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 3RD ST SW PMB# 174
WINTER HAVEN FL
33880
US

IV. Provider business mailing address

102 LANDINGS WAY APT 9C
WINTER HAVEN FL
33880-5327
US

V. Phone/Fax

Practice location:
  • Phone: 904-420-0461
  • Fax:
Mailing address:
  • Phone: 404-434-3528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LYNDAL EDWIN BEDFORD
Title or Position: CEO/FOUNDER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 404-434-3528