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General NPI Number Information
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NPI Number | 1154207157
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Entity Type | Organization
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Legal Business Name | BRIDGE THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1519 EAGLE AVE
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City | NORFOLK
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State | VA
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Zip | 23518-2931
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Country | US
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Telephone | 757-777-3787
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Fax |
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Provider Business Mailing Address
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Address Line | 999 WATERSIDE DR STE 2525
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City | NORFOLK
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State | VA
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Zip | 23510-3316
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Country | US
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Telephone | 757-777-3787
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Fax |
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Authorized Official
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Title or Position | ADMIN/CREDENTIALING SPECIALIST
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Name | FRANCES GIBBS
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Credential |
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Telephone | 757-354-4517
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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 |
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License Number State |
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