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General NPI Number Information
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NPI Number | 1841760808
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Entity Type | Organization
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Legal Business Name | BRIDGING LEGACIES II
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 1510 ROSE TERRACE CIR
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City | LOGANVILLE
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State | GA
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Zip | 30052-9041
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Country | US
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Telephone | 910-467-6645
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Fax |
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Provider Business Mailing Address
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Address Line | 125 KILLIS BLVD
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City | RICHLANDS
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State | NC
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Zip | 28574-6397
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Country | US
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Telephone | 910-467-6645
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TIARA NICOLE HEDGEPETH
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Credential |
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Telephone | 910-467-6645
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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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