Provider Demographics
NPI:1730628157
Name:BRIDGES FAMILY LIFE CENTER PLLC
Entity type:Organization
Organization Name:BRIDGES FAMILY LIFE CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-813-0352
Mailing Address - Street 1:401 AVERSBORO RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3633
Mailing Address - Country:US
Mailing Address - Phone:919-813-0352
Mailing Address - Fax:
Practice Address - Street 1:401 AVERSBORO RD
Practice Address - Street 2:STE 100
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3633
Practice Address - Country:US
Practice Address - Phone:919-813-0352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty