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General NPI Number Information
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NPI Number | 1457788069
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Entity Type | Organization
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Legal Business Name | BRIDGE BUILDERS MEDIATION AND FAMILY SERVICES
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 1460 CASSAT AVE STE B
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City | JACKSONVILLE
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State | FL
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Zip | 32205-7202
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Country | US
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Telephone | 904-338-6435
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6763
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City | JACKSONVILLE
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State | FL
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Zip | 32236-6763
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Country | US
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Telephone | 904-338-6435
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CYNTHIA ANN SIMPSON
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Credential | PH. D.
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Telephone | 904-300-6563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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