Provider Demographics
NPI:1922204296
Name:THE BRIDGE CENTER FOR GROWTH, PC.
Entity Type:Organization
Organization Name:THE BRIDGE CENTER FOR GROWTH, PC.
Other - Org Name:JANICE ACKER, PSY.D., LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:734-675-9700
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-0004
Mailing Address - Country:US
Mailing Address - Phone:734-675-9700
Mailing Address - Fax:
Practice Address - Street 1:23933 ALLEN RD STE 15
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3369
Practice Address - Country:US
Practice Address - Phone:734-675-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION73680Medicare ID - Type Unspecified