Organization
LISA G. BRIDGEWATER, PH.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA BRIDGEWATER PH.D. (PRESIDENT)
(803) 517-0322
Entity
Organization
Contact information
Practice address
229 JOHNSTON ST, ROCK HILL, SC 29730-3579
(803) 517-0322
(803) 328-1866
Mailing address
PO BOX 828, CHESTER, SC 29706-0828
(803) 517-0322
(803) 328-1866
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
11/25/2013
Last updated
11/25/2013
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