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General NPI Number Information
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NPI Number | 1487172110
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Entity Type | Organization
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Legal Business Name | BRIDGES INTERNATIONAL CENTERS FOR RECOVERY AND REENTRY, INC.
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2145 METROCENTER BLVD STE 350
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City | ORLANDO
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State | FL
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Zip | 32835
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Country | US
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Telephone | 407-218-4791
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 METROCENTER BLVD STE 350
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City | ORLANDO
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State | FL
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Zip | 32835-7642
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Country | US
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Telephone | 407-218-4791
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FAMILY SERVICES
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Name | TERESA MITCHEM
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Credential | MS, IMH
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Telephone | 407-218-4791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 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 #5
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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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