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General NPI Number Information
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NPI Number | 1033543079
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Entity Type | Individual
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Provider Name | REBECCA BRIDGES
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Gender | Female
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 301 FORT LN
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2221
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Country | US
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Telephone | 757-391-6763
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 KALONA RD
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City | PORTSMOUTH
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State | VA
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Zip | 23703-2065
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Country | US
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Telephone | 757-334-1984
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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