Provider Demographics
NPI:1285223081
Name:BRIDGE, MARISA L (LPC, CDCA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:L
Last Name:BRIDGE
Suffix:
Gender:F
Credentials:LPC, CDCA
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:L
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 PEMBROKE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6404
Mailing Address - Country:US
Mailing Address - Phone:724-396-1510
Mailing Address - Fax:724-972-4627
Practice Address - Street 1:388 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507-1948
Practice Address - Country:US
Practice Address - Phone:724-396-1510
Practice Address - Fax:724-972-4627
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180703101YA0400X
OHCDCA.176188101YA0400X
OHC.2204107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)