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General NPI Number Information
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NPI Number | 1396706818
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Entity Type | Organization
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Legal Business Name | FAMILY BRIDGES THERAPEUTIC ASSOCIATES LLC
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Dates
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Enumeration Date | 04/01/2006
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Last Update Date | 06/13/2010
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Provider Practice Location Address
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Address Line | 635 S HAZARD ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-4728
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Country | US
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Telephone | 843-249-1781
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Fax | 360-364-3499
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Provider Business Mailing Address
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Address Line | 635 S HAZARD ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-4728
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Country | US
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Telephone | 843-240-1781
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Fax | 888-282-6745
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. MICHAEL J MANGIN
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Credential | MED
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Telephone | 843-240-1781
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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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