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General NPI Number Information
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NPI Number | 1922728609
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Entity Type | Organization
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Legal Business Name | BRISTOL ASCENSION ENTERPRISES, LLC
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 7238 MUNCASTER MILL RD STE 213
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City | DERWOOD
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State | MD
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Zip | 20855-1215
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Country | US
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Telephone | 240-389-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 8228 CASTLEBURY TER
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City | GAITHERSBURG
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State | MD
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Zip | 20879-5516
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Country | US
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Telephone | 301-275-0954
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | MR. SCOTT MAURICE BRISTOL JR.
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Credential | LGPC
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Telephone | 240-389-4331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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