Healthcare Provider Details

I. General information

NPI: 1700017621
Provider Name (Legal Business Name): BRIDGEWATER COUNSELING SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MAIN ST
BRIDGEWATER VA
22812-1132
US

IV. Provider business mailing address

100 S MAIN ST
BRIDGEWATER VA
22812-1132
US

V. Phone/Fax

Practice location:
  • Phone: 540-828-3663
  • Fax: 540-828-2322
Mailing address:
  • Phone: 540-828-3663
  • Fax: 540-828-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0812000382
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002990
License Number StateVA

VIII. Authorized Official

Name: MRS. REBEKAH A ABRISZ
Title or Position: MANAGER
Credential:
Phone: 804-986-2180