Provider Demographics
NPI:1467520734
Name:BRIDGES COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:BRIDGES COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:401-722-9091
Mailing Address - Street 1:100 LAFAYETTE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6008
Mailing Address - Country:US
Mailing Address - Phone:401-722-9091
Mailing Address - Fax:401-722-5451
Practice Address - Street 1:100 LAFAYETTE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6008
Practice Address - Country:US
Practice Address - Phone:401-722-9091
Practice Address - Fax:401-722-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW 003531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty