Healthcare Provider Details

I. General information

NPI: 1790854222
Provider Name (Legal Business Name): THE BRIDGES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PRESIDENTIAL PKWY
ATLANTA GA
30340-3705
US

IV. Provider business mailing address

3855 PRESIDENTIAL PKWY
ATLANTA GA
30340-3705
US

V. Phone/Fax

Practice location:
  • Phone: 770-451-6838
  • Fax:
Mailing address:
  • Phone: 770-451-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberLPC003650
License Number StateGA

VIII. Authorized Official

Name: MS. ELANA TERRY
Title or Position: PROGRAM DIRECTOR
Credential: MED LPC
Phone: 770-451-6838