Provider Demographics
NPI:1790265783
Name:BRIDGEPOINTE THERAPY LLC
Entity Type:Organization
Organization Name:BRIDGEPOINTE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELKNAP
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:703-919-2691
Mailing Address - Street 1:1365 ASHLEY RIVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5379
Mailing Address - Country:US
Mailing Address - Phone:843-628-6381
Mailing Address - Fax:
Practice Address - Street 1:1365 ASHLEY RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5379
Practice Address - Country:US
Practice Address - Phone:843-628-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12489261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health