Provider Demographics
NPI:1083075709
Name:BRIDGES 2 PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:BRIDGES 2 PSYCHOLOGICAL SERVICES LLC
Other - Org Name:BRIDGES 2 PSYCHOLOGICAL SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINICAL DIRECTOR/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:202-849-2915
Mailing Address - Street 1:639 ATLANTIC ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3738
Mailing Address - Country:US
Mailing Address - Phone:202-849-2915
Mailing Address - Fax:202-627-2058
Practice Address - Street 1:639 ATLANTIC ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3738
Practice Address - Country:US
Practice Address - Phone:202-849-2915
Practice Address - Fax:202-627-5028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty