Healthcare Provider Details

I. General information

NPI: 1972631141
Provider Name (Legal Business Name): A BRIDGE TO RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 TOWNE CENTER BLVD STE 1300
RIDGELAND MS
39157-4863
US

IV. Provider business mailing address

361 TOWNE CENTER BLVD STE 1300
RIDGELAND MS
39157-4863
US

V. Phone/Fax

Practice location:
  • Phone: 601-977-9353
  • Fax:
Mailing address:
  • Phone: 601-977-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1225
License Number StateMS

VIII. Authorized Official

Name: MR. SCOTT RICHARD GILBERT
Title or Position: PRESIDENT
Credential:
Phone: 601-977-9353