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Organization
BRIDGEWATER SUPPORT SERVICES, LLC
Active
Organization
BRIDGEWATER SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMBER DAWN BURKHARDT-SIDEBOTTOM LMSW (CLINICAL SOCIAL WORKER)
(734) 276-2765
Entity
Organization
Contact information
Practice address
8139 ERNST RD, MANCHESTER, MI 48158-9565
(734) 276-2765
Mailing address
8139 ERNST RD, MANCHESTER, MI 48158-9565
(734) 276-2765
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
6801087977
MI
261QM0850X
Adult Mental Health Clinic/Center
6801087977
MI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
6801087977
MI
Other
Enumeration date
01/18/2015
Last updated
01/18/2015
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