Organization
BRIDGEWATER COUNSELING SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT W MANDEVILLE LCSW (OWNER)
(540) 828-3663
Entity
Organization
Contact information
Practice address
108 WEST COLLEGE STREET, BRIDGEWATER, VA 22812-1124
(540) 828-3663
(540) 828-2322
Mailing address
108 WEST COLLEGE STREET, BRIDGEWATER, VA 22812-1124
(540) 828-3663
(540) 828-2322
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0812000382
VA
1041C0700X
Clinical Social Worker
Primary
0904002990
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891959169
—
VA
01
—
219164
COM-PSYCH
VA
Enumeration date
07/15/2008
Last updated
12/13/2012
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