Healthcare Provider Details

I. General information

NPI: 1447901434
Provider Name (Legal Business Name): BRIDGES FAMILY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 WEBER INDUSTRIAL DR
CUMMING GA
30041-6468
US

IV. Provider business mailing address

219 RAINHILL STATION DR
DAWSONVILLE GA
30534-3583
US

V. Phone/Fax

Practice location:
  • Phone: 470-798-0395
  • Fax: 678-807-1300
Mailing address:
  • Phone: 478-919-8244
  • Fax: 678-807-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS ADAMS PARKER
Title or Position: OWNER
Credential: LPC
Phone: 470-798-0094