Healthcare Provider Details

I. General information

NPI: 1235430265
Provider Name (Legal Business Name): BRIDGEBUILDERS FAMILY & YOUTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 EBENEZER RD STE G2
ROCK HILL SC
29732-1078
US

IV. Provider business mailing address

2025 EBENEZER RD STE G2
ROCK HILL SC
29732-1078
US

V. Phone/Fax

Practice location:
  • Phone: 803-619-6900
  • Fax: 803-619-6913
Mailing address:
  • Phone: 803-619-6900
  • Fax: 803-619-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON TYRONNE GRIER
Title or Position: EXECUTIVE DIRECTOR
Credential: BA
Phone: 704-451-7630