Provider Demographics
NPI:1205193737
Name:BRIDGES BEHAVIORAL HEALTH & WELLNESS
Entity type:Organization
Organization Name:BRIDGES BEHAVIORAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DADDS
Authorized Official - Suffix:
Authorized Official - Credentials:LGSW
Authorized Official - Phone:410-708-7626
Mailing Address - Street 1:207 N LIBERTY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-1022
Mailing Address - Country:US
Mailing Address - Phone:410-758-8750
Mailing Address - Fax:410-758-8751
Practice Address - Street 1:207 N LIBERTY ST
Practice Address - Street 2:SUITE B
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1022
Practice Address - Country:US
Practice Address - Phone:410-758-8750
Practice Address - Fax:410-758-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health