Healthcare Provider Details

I. General information

NPI: 1649574856
Provider Name (Legal Business Name): BRIDGE FOR GOOD ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 MONUMENT AVE # 301
RICHMOND VA
23220-2943
US

IV. Provider business mailing address

1617 MONUMENT AVE # 301
RICHMOND VA
23220-2943
US

V. Phone/Fax

Practice location:
  • Phone: 804-562-6604
  • Fax: 804-308-0551
Mailing address:
  • Phone: 804-562-6604
  • Fax: 804-308-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN S. LEVENSTON
Title or Position: DIRECTOR
Credential: LCSW
Phone: 804-562-6604