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General NPI Number Information
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NPI Number | 1154145134
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Entity Type | Organization
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Legal Business Name | FIVE BRIDGES COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 2415 BARTON AVE
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City | RICHMOND
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State | VA
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Zip | 23222-4415
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Country | US
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Telephone | 804-241-4931
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E FRANKLIN STREET SUITE 105 #1367
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City | RICHMOND
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State | VA
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Zip | 23219
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Country | US
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Telephone | 804-241-4931
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | TAYLOR DAHL
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Credential | LPC
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Telephone | 804-241-4931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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