Organization
NEW ROOTS BRIDGEWAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEA NICHOLSON LMAC, LMFT (CEO)
(785) 342-0437
Entity
Organization
Contact information
Practice address
4208 E CENTRAL AVE, WICHITA, KS 67208-3822
(316) 351-8280
Mailing address
4208 E CENTRAL AVE, WICHITA, KS 67208-3822
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
04/05/2022
Last updated
02/13/2025
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