Provider Demographics
NPI:1144793118
Name:BRIDGE TO RESOLUTION COUNSELING AND REHABILITATION
Entity Type:Organization
Organization Name:BRIDGE TO RESOLUTION COUNSELING AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHCI
Authorized Official - Phone:904-566-0200
Mailing Address - Street 1:1164 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-3215
Mailing Address - Country:US
Mailing Address - Phone:904-566-0200
Mailing Address - Fax:
Practice Address - Street 1:5991 CHESTER AVE STE 211
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2245
Practice Address - Country:US
Practice Address - Phone:904-566-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty