Provider Demographics
NPI:1518205798
Name:BRIDGE BUILDERS COUNSELING & MENTORING, INC.
Entity Type:Organization
Organization Name:BRIDGE BUILDERS COUNSELING & MENTORING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-987-8772
Mailing Address - Street 1:1220 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5349
Mailing Address - Country:US
Mailing Address - Phone:810-987-8772
Mailing Address - Fax:810-987-8706
Practice Address - Street 1:1220 6TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5349
Practice Address - Country:US
Practice Address - Phone:810-987-8772
Practice Address - Fax:810-987-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI740082251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health