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General NPI Number Information
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NPI Number | 1396959268
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Entity Type | Organization
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Legal Business Name | BAY BRIDGE COUNSELING, LLC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 1648 BAY AVE SUITE 2
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City | POINT PLEASANT BORO
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State | NJ
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Zip | 08742-4502
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Country | US
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Telephone | 732-899-0701
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Fax | 723-899-6962
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Provider Business Mailing Address
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Address Line | 1648 BAY AVE SUITE 2
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City | POINT PLEASANT BORO
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State | NJ
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Zip | 08742-4502
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Country | US
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Telephone | 732-899-0701
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Fax | 723-899-6962
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Authorized Official
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Title or Position | LCSW
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Name | MRS. CHRISTA NOELLE HOGAN
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Credential | LCSW
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Telephone | 732-899-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 44SC05270600
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License Number State | NJ
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