Provider Demographics
NPI:1891121679
Name:BRIDGES R.E.S.P.I.T.E SERVICES, PLLC
Entity Type:Organization
Organization Name:BRIDGES R.E.S.P.I.T.E SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW
Authorized Official - Phone:734-658-3273
Mailing Address - Street 1:PO BOX 87474
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-0474
Mailing Address - Country:US
Mailing Address - Phone:734-658-3273
Mailing Address - Fax:734-484-5475
Practice Address - Street 1:8598 INDIGO CT
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1068
Practice Address - Country:US
Practice Address - Phone:734-658-3273
Practice Address - Fax:734-484-5475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010857961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty