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General NPI Number Information
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NPI Number | 1942724299
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Entity Type | Organization
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Legal Business Name | BRIDGE OF FAITH, LLC
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 10 E CHURCH ST STE JMC
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City | MARTINSVILLE
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State | VA
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Zip | 24112-6204
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Country | US
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Telephone | 276-656-6500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 444
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City | MARTINSVILLE
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State | VA
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Zip | 24114-0444
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO- OWNER
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Name | MRS. MARKEYITA MURDOCK
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Credential |
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Telephone | 336-287-6755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2451
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License Number State | VA
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