Provider Demographics
NPI:1235742552
Name:THE BRIDGE THERAPEUTIC & EVALUATION SERVICES, LLC
Entity Type:Organization
Organization Name:THE BRIDGE THERAPEUTIC & EVALUATION SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON-PLATER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-938-7276
Mailing Address - Street 1:7311 ZEKIAH CT
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5940
Mailing Address - Country:US
Mailing Address - Phone:301-938-7276
Mailing Address - Fax:
Practice Address - Street 1:7360 GRACE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2470
Practice Address - Country:US
Practice Address - Phone:202-731-7352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty