Organization
MARK BOGERT
Active
Other names
LifeBridge Counseling, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M MCDOWELL LPC, LSATP, NCC (DIRECTOR)
(540) 523-8054
Entity
Organization
Contact information
Practice address
5673 AIRPORT RD, ROANOKE, VA 24012-1119
(540) 523-8080
(540) 562-8867
Mailing address
5673 AIRPORT RD, ROANOKE, VA 24012-1119
(540) 523-8080
(540) 512-9775
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
601035424
—
VA
Enumeration date
07/22/2015
Last updated
11/08/2016
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