Provider Demographics
NPI:1396706818
Name:FAMILY BRIDGES THERAPEUTIC ASSOCIATES LLC
Entity type:Organization
Organization Name:FAMILY BRIDGES THERAPEUTIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:843-240-1781
Mailing Address - Street 1:635 S HAZARD ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-4728
Mailing Address - Country:US
Mailing Address - Phone:843-240-1781
Mailing Address - Fax:888-282-6745
Practice Address - Street 1:635 S HAZARD ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-4728
Practice Address - Country:US
Practice Address - Phone:843-249-1781
Practice Address - Fax:360-364-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-01
Last Update Date:2010-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty