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General NPI Number Information
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NPI Number | 1831682665
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Entity Type | Organization
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Legal Business Name | FAMILY TIES OF BRUNSWICK, LLC
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 720 N 3RD ST STE 401
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City | WILMINGTON
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State | NC
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Zip | 28401-3474
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Country | US
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Telephone | 910-769-9126
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Fax | 910-769-9169
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Provider Business Mailing Address
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Address Line | 720 N 3RD ST STE 401
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City | WILMINGTON
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State | NC
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Zip | 28401-3474
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Country | US
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Telephone | 910-769-9126
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Fax | 910-769-9169
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRIDGET DIXON MILLIKEN
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Credential | LCMHC, LCASA
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Telephone | 910-393-8502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 9796
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License Number State | NC
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Taxonomy #3
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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 #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 20956
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License Number State | NC
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