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General NPI Number Information
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NPI Number | 1083075709
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Entity Type | Organization
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Legal Business Name | BRIDGES 2 PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 639 ATLANTIC ST SE
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City | WASHINGTON
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State | DC
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Zip | 20032-3738
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Country | US
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Telephone | 202-849-2915
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Fax | 202-627-5028
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Provider Business Mailing Address
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Address Line | 639 ATLANTIC ST SE
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City | WASHINGTON
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State | DC
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Zip | 20032-3738
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Country | US
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Telephone | 202-849-2915
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Fax | 202-627-2058
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/PSYCHOLOGIST
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Name | DR. ANGELINA DICKERSON
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Credential | PSY.D.
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Telephone | 202-849-2915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY1000835
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License Number State | DC
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