Provider Demographics
NPI:1215560396
Name:BRIDGE TO HOLISTIC HEALING, LLC
Entity Type:Organization
Organization Name:BRIDGE TO HOLISTIC HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:240-767-6966
Mailing Address - Street 1:223 N PROSPECT ST STE 306
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-3783
Mailing Address - Country:US
Mailing Address - Phone:240-767-6966
Mailing Address - Fax:301-579-0037
Practice Address - Street 1:223 N PROSPECT ST STE 306
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3783
Practice Address - Country:US
Practice Address - Phone:240-767-6966
Practice Address - Fax:301-579-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center