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General NPI Number Information
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NPI Number | 1689963449
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Entity Type | Organization
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Legal Business Name | BRIDGES COUNSELING
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 109 MAIN ST SUITE 2
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1453
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Country | US
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Telephone | 973-634-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 109 MAIN ST SUITE 2
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City | SUCCASUNNA
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State | NJ
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Zip | 07876-1453
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Country | US
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Telephone | 973-668-4806
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/SOLE PROPRIETOR
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Name | MS. HEATHER DIDOMENICO
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Credential | LPC
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Telephone | 973-634-5171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00317200
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License Number State | NJ
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