Provider Demographics
NPI:1366167256
Name:BRIDGE TO AFFECTIVE WELLNES, PLLC
Entity type:Organization
Organization Name:BRIDGE TO AFFECTIVE WELLNES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:MASSEY
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-272-1908
Mailing Address - Street 1:1028 LEE-ANN DR. NE
Mailing Address - Street 2:SUITE 60
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2903
Mailing Address - Country:US
Mailing Address - Phone:980-272-1908
Mailing Address - Fax:704-787-9920
Practice Address - Street 1:1028 LEE-ANN DR. NE
Practice Address - Street 2:SUITE 60
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2903
Practice Address - Country:US
Practice Address - Phone:980-272-1908
Practice Address - Fax:704-787-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty