Provider Demographics
NPI:1467082651
Name:THE B.R.I.D.G.E COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:THE B.R.I.D.G.E COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAQUANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:CCTP, NCC, LPC
Authorized Official - Phone:334-245-3361
Mailing Address - Street 1:1775 TALIAFERRO TRL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7758
Mailing Address - Country:US
Mailing Address - Phone:334-245-3361
Mailing Address - Fax:334-239-7716
Practice Address - Street 1:1775 TALIAFERRO TRL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7758
Practice Address - Country:US
Practice Address - Phone:334-245-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health