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General NPI Number Information
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NPI Number | 1073616678
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Entity Type | Organization
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Legal Business Name | BRIDGE COUNSELING AND THERAPY CENTER, LLC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 32 BRIDGEVILLE RD
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City | GEORGETOWN
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State | DE
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Zip | 19947-2106
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Country | US
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Telephone | 302-856-9190
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Fax | 302-856-9133
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Provider Business Mailing Address
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Address Line | 32 BRIDGEVILLE RD
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City | GEORGETOWN
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State | DE
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Zip | 19947-2106
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Country | US
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Telephone | 302-856-9190
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Fax | 302-856-9133
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JOEL A VANINI
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Credential | LCSW
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Telephone | 302-856-9190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q100000281
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License Number State | DE
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