NPIMap

Organization Active NPI

Family Bridges Therapeutic Associates LLC

  • Mental Health Counselor
  • Georgetown, SC
National Provider Identifier
1396706818
Registry record updated Jun 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
FAMILY BRIDGES THERAPEUTIC ASSOCIATES LLC
Practice address
635 S Hazard St
Georgetown, SC 29440-4728
Phone
(843) 249-1781
Fax
(360) 364-3499
NPI assigned
Apr 1, 2006
Last updated
Jun 13, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael J Mangin, MED
Title
Office Manager
Phone
(843) 240-1781

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

635 S Hazard St
Georgetown, SC 29440-4728

Mailing address

635 S Hazard St
Georgetown, SC 29440-4728
Phone (843) 240-1781

National Provider Directory

National Provider Directory

Locations

635 S Hazard St
Georgetown, SC 29440
Phone (843) 240-1783

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276387200000",
    "number": "1396706818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 S HAZARD ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294404728",
            "telephone_number": "843-240-1781",
            "fax_number": "888-282-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 S HAZARD ST",
            "city": "GEORGETOWN",
            "state": "SC",
            "postal_code": "294404728",
            "telephone_number": "843-249-1781",
            "fax_number": "360-364-3499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY BRIDGES THERAPEUTIC ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-01",
        "last_updated": "2010-06-13",
        "status": "A",
        "authorized_official_last_name": "MANGIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "843-240-1781",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MED"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.