Organization
BRIDGE TO PURPOSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUA WALLACE (OWNER)
(614) 626-1266
Entity
Organization
Contact information
Practice address
4207 E BROAD ST STE A, COLUMBUS, OH 43213-1200
(614) 626-1266
(614) 626-1266
Mailing address
4207 E BROAD ST STE A, COLUMBUS, OH 43213-1200
(614) 626-1266
(614) 626-1266
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
3245S0500X
Children's Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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