| Bridgestone Mental Wellness & Therapy | |
|
43736 Tolamac Dr Ashburn VA 20147-4761 | |
| (240) 441-1888 | |
| Not Available |
| Full Name | Bridgestone Mental Wellness & Therapy |
|---|---|
| Speciality | Clinic/Center |
| Location | 43736 Tolamac Dr, Ashburn, Virginia |
| Authorized Official Name and Position | Bridget Famogun (PROVIDER) |
| Authorized Official Contact | 2404411888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgestone Mental Wellness & Therapy 43736 Tolamac Dr Ashburn VA 20147-4761 Ph: (240) 441-1888 | Bridgestone Mental Wellness & Therapy 43736 Tolamac Dr Ashburn VA 20147-4761 Ph: (240) 441-1888 |
| NPI Number | 1235992322 |
|---|---|
| Provider Enumeration Date | 02/01/2024 |
| Last Update Date | 02/01/2024 |
| Certification Date | 02/01/2024 |
| Medicare PECOS PAC ID | 4183063357 |
|---|---|
| Medicare Enrollment ID | O20240419003569 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235992322 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Bridget U Famogun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679110951 PECOS PAC ID: 3678992443 Enrollment ID: I20201105000137 |
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