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General NPI Number Information
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NPI Number | 1417619610
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Entity Type | Individual
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Provider Name | TASHA A BRIDGES
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Gender | Female
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 17515 W 9 MILE RD STE 240
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4423
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Country | US
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Telephone | 248-579-2188
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Fax |
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Provider Business Mailing Address
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Address Line | 29235 KENSINGTON CT.
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-259-5276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451016555
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License Number State | MI
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