Organization Name: | BRIDGEPATH INC |
NPI Number: | 1578951109 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES PRUETT (OWNER) |
Mailing Address: | 664 W Heatherstone Ln Roebuck |
State: | SC US |
Postal Code: | 293762787 |
Phone Number: | 7045775862 |
Fax Number: | |
NPI Enumeration Date: | 01/06/2015 |
NPI Last Update Date: | 01/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP1600X |
License Number: | 4663 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Pastoral |
Taxonomy Definition: |