1700338175 NPI number — THE BRIDGE COUNSELING CENTER, LLC

Table of content: MARIA ANN SPEED MSW (NPI 1518504745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700338175 NPI number — THE BRIDGE COUNSELING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE BRIDGE COUNSELING CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700338175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 CONCORD RD SE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30080-5306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-474-7666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1260 CONCORD RD SE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30080-5306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-474-7666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ESKRIDGE
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
'AMANDA'
Authorized Official Title or Position:
LPC
Authorized Official Telephone Number:
404-358-1820

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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