Provider Demographics
NPI:1700017621
Name:BRIDGEWATER COUNSELING SERVICES, PC
Entity Type:Organization
Organization Name:BRIDGEWATER COUNSELING SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABRISZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-986-2180
Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1132
Mailing Address - Country:US
Mailing Address - Phone:540-828-3663
Mailing Address - Fax:540-828-2322
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:VA
Practice Address - Zip Code:22812-1132
Practice Address - Country:US
Practice Address - Phone:540-828-3663
Practice Address - Fax:540-828-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000382101YM0800X
VA09040029901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO86454MOtherOPTIMA
VA008954585Medicaid
VA462838OtherANTHEM
VA00W232B01Medicare UPIN