# BRIDGEPATH INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578951109
- **Authorized official:** DR. JEAN SMITH PRUETT D.MIN., LPC, HTCP/I (SECRETARY/TREASURER)
- **Authorized official phone:** (704) 651-2895

## Contact information

- **Practice address:** 3900-B PARK RD, CHARLOTTE, NC 28209
- **Practice address phone:** (704) 577-5862
- **Mailing address:** 664 W HEATHERSTONE LN, ROEBUCK, SC 29376-2787
- **Mailing address phone:** (704) 651-2895
- **Mailing address fax:** (864) 574-8142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP1600X | Pastoral Counselor | 2004 | NC | — |
| 101YP1600X | Pastoral Counselor | 4663 | NC | — |
| 106H00000X | Marriage & Family Therapist | 15 | SC | Yes |

## Other

- **Enumeration date:** 01/06/2015
- **Last updated:** 02/17/2017