Healthcare Provider Details

I. General information

NPI: 1720525413
Provider Name (Legal Business Name): BRIDGEWAY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 05/07/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 SOUTH MAIN ST SUITE 303
WOLFEBORO NH
03894-3848
US

IV. Provider business mailing address

284 CENTER ST
WOLFEBORO NH
03894
US

V. Phone/Fax

Practice location:
  • Phone: 603-834-9944
  • Fax:
Mailing address:
  • Phone: 603-834-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNH

VIII. Authorized Official

Name: JOSEPH MICHAEL BROWN
Title or Position: OWNER
Credential: MS, LCMHC
Phone: 603-834-9944