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Organization
BRIDGEPATH INC
Active
Organization
BRIDGEPATH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEAN SMITH PRUETT D.MIN., LPC, HTCP/I (SECRETARY/TREASURER)
(704) 651-2895
Entity
Organization
Contact information
Practice address
3900-B PARK RD, CHARLOTTE, NC 28209
(704) 577-5862
Mailing address
664 W HEATHERSTONE LN, ROEBUCK, SC 29376-2787
(704) 651-2895
(864) 574-8142
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
2004
NC
101YP1600X
Pastoral Counselor
4663
NC
106H00000X
Marriage & Family Therapist
Primary
15
SC
Other
Enumeration date
01/06/2015
Last updated
02/17/2017
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