Provider Demographics
NPI:1306350012
Name:BRIDGES THERAPEUTIC SERVICES PLLC
Entity type:Organization
Organization Name:BRIDGES THERAPEUTIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-762-1361
Mailing Address - Street 1:10643 KETTERING DR STE 109
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4900
Mailing Address - Country:US
Mailing Address - Phone:704-762-1361
Mailing Address - Fax:980-505-8947
Practice Address - Street 1:10643 KETTERING DR STE 109
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4900
Practice Address - Country:US
Practice Address - Phone:704-762-1361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8478101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty