Provider Demographics
NPI:1457788069
Name:BRIDGE BUILDERS MEDIATION AND FAMILY SERVICES
Entity Type:Organization
Organization Name:BRIDGE BUILDERS MEDIATION AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:904-300-6563
Mailing Address - Street 1:PO BOX 6763
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-6763
Mailing Address - Country:US
Mailing Address - Phone:904-338-6435
Mailing Address - Fax:
Practice Address - Street 1:1460 CASSAT AVE STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7202
Practice Address - Country:US
Practice Address - Phone:904-338-6435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty