Doctor Name: | MRS. VELESSAUNIA BRIDGES-WILSON |
NPI Number: | 1649501503 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSC, LLPC |
License Number: | |
Business Practice Address: | 790 Fuller Ave Ne Grand Rapids, MI - 495031918 |
Business Phone Number: | 6163363909 |
Business Fax Number: | |
Mailing Address: | 790 Fuller Ave Ne, GRAND RAPIDS |
State: | MI |
Postal Code: | 495031918 |
Phone Number: | 6163363909 |
Fax Number: | |
NPI Enumeration Date: | 01/15/2010 |
NPI Last Update Date: | 03/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |