Healthcare Provider Details

I. General information

NPI: 1134577752
Provider Name (Legal Business Name): BRIDGE PLAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 VILLAGE HARBOR DR
CORNELIUS NC
28031-3706
US

IV. Provider business mailing address

8211 VILLAGE HARBOR DR
CORNELIUS NC
28031-3706
US

V. Phone/Fax

Practice location:
  • Phone: 704-896-7876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007710
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2454
License Number StateNC

VIII. Authorized Official

Name: DR. CAROL ARMSTRONG
Title or Position: OWNER
Credential: PSY.D.
Phone: 704-896-7876