Provider Demographics
NPI:1922728609
Name:BRISTOL ASCENSION ENTERPRISES, LLC
Entity Type:Organization
Organization Name:BRISTOL ASCENSION ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:BRISTOL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LGPC
Authorized Official - Phone:240-389-4331
Mailing Address - Street 1:8228 CASTLEBURY TER
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5516
Mailing Address - Country:US
Mailing Address - Phone:301-275-0954
Mailing Address - Fax:
Practice Address - Street 1:7238 MUNCASTER MILL RD STE 213
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1215
Practice Address - Country:US
Practice Address - Phone:240-389-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health