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General NPI Number Information
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NPI Number | 1346753399
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Entity Type | Organization
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Legal Business Name | THE BRIDGE COUNSELING AND CONSULTATION CENTER
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 761 POPLAR ST STE 1K
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City | MACON
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State | GA
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Zip | 31201-2061
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Country | US
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Telephone | 478-957-4482
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Fax |
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Provider Business Mailing Address
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Address Line | 195 SUN VALLEY DR
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City | MACON
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State | GA
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Zip | 31211-7415
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Country | US
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Telephone | 478-957-4482
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MRS. JADA MCNAIR ELLIOTT
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Credential | LMSW
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Telephone | 478-957-4482
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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 | CSW005145
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License Number State | GA
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