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General NPI Number Information
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NPI Number | 1396279824
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Entity Type | Organization
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Legal Business Name | THE BRIDGES WELLNESS GROUP, LLC.
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 7050 CHESAPEAKE RD STE 104
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City | HYATTSVILLE
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State | MD
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Zip | 20784
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Country | US
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Telephone | 407-707-2042
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Fax | 866-473-0669
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Provider Business Mailing Address
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Address Line | 7050 CHESAPEAKE RD STE 104
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City | HYATTSVILLE
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State | MD
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Zip | 20784-2345
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Country | US
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Telephone | 240-770-7204
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. MARVIN NICKLESON BATTLE JR.
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Credential | LCPC, LPC
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Telephone | 703-225-9118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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