SOUTHERN BRIDGE INC (NPI# 1386097848) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386097848 |
| Entity Type | Organization |
| Organization Name | SOUTHERN BRIDGE INC |
| Practice Address |
109 Osigian Blvd Ste 400 Warner Robins GA 31088-8925 |
| Practice Telephone | 4784491475 |
| Practice Fax Number | 8777124794 |
| Mailing Telephone | 4784491475 |
| Mailing Fax Number | 8777124794 |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2019-12-17 |
| Authorized Official Name | NEVA D EVANS (CEO) |
| Authorized Official Telephone | 4784491475 |
| Authorized Official Credential | LMFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003222274A | 05 | |
| GA | 003209756A | 05 | |
| GA | 003220322A | 05 | |
| GA | 003174143A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3100 Moody Rd, Suite A, Bonaire, GA 310054139 | 4784491475 | 8777124794 |
| Street Address |
109 OSIGIAN BLVD STE 400 |
| City | WARNER ROBINS |
| State | GA |
| Zip Code | 31088-8925 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780041822 | Neva Danielle Evans | Marriage & Family Therapist | 109 Osigian Blvd Ste 400, Warner Robins, GA 31088-8925 | 2016-01-20 |
| 1801447966 | Irwin Clyde Rutherford Jr. | Counselor | 109 Osigian Blvd Ste 400, Warner Robins, GA 31088-8925 | 2019-09-20 |
| 1528612876 | Jamie Eileen Tillit | Counselor | 109 Osigian Blvd Ste 400, Warner Robins, GA 31088-8925 | 2019-07-25 |
| 1730629908 | Jean Geherin Hatt | Counselor | 109 Osigian Blvd Ste 400, Warner Robins, GA 31088-8925 | 2017-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982218921 | Sarah Newman | Pharmacist | 1081 Ga-96, Warner Robins, GA 31088 | 2020-09-08 |
| 1619599115 | Alana Jane Sibley | Registered Nurse | 940 Ga - 96, Warner Robins, GA 31088 | 2020-05-07 |
| 1033779657 | Jodi Lynne Pettygrove | Nurse Practitioner | 115 Havelock Cir, Warner Robins, GA 31088 | 2019-06-17 |
| 1164994901 | Gwendolyn Jordan Taylor | Registered Nurse | 940-c Ga Hwy 96, Same, Warner Robins, GA 31088 | 2018-12-18 |
| 1447721543 | Amy Tanner | Behavioral Analyst | 200 Cresview Church Rd #1806, Warner Robins, GA 31088 | 2018-12-16 |
| 1518435676 | Phoenix Health Center | Case Management | 940 Ga-96, Warner Robins, GA 31088 | 2018-11-07 |
| 1427534320 | Jared Dean Johnson | Social Worker | 146 Lakepointe Drive, Warner Robins, GA 31088 | 2018-07-13 |
| 1285124180 | Cmp Academy & Billing Service | Contractor | 105 S Commercial Circle, Warner Robins, GA 31088 | 2018-05-16 |
| 1730692377 | Benzer Pharmacy | Pharmacy | 150 S Houston Lake Rd Ste 300, Warner Robins, GA 31088 | 2017-11-06 |
| 1821507476 | Timothy Doyle Thomas | Registered Nurse | 940-c Hwy 96, Warner Robins, GA 31088 | 2017-09-27 |
| Find all providers in zip 31088 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497224927 | Rebecca Watson Frazier | Marriage & Family Therapist | 404 Corder Rd Ste 100, Warner Robins, GA 31088-7196 | 2018-11-14 |
| 1033684097 | Cecilia Mitchell | Marriage & Family Therapist | 333 Margie Dr # C, Warner Robins, GA 31088-0805 | 2018-10-05 |
| 1417463571 | Shirley Therapeutic and Consulting Services, LLC | Marriage & Family Therapist | 611 Russell Pkwy Ste A, Warner Robins, GA 31088-7691 | 2017-12-27 |
| 1952848129 | Rebacca Lynn Klimowicz | Marriage & Family Therapist | 607 A Russell Parkway, Warner Robins, GA 31088 | 2017-01-26 |
| 1710346903 | Brenda Marie Warren | Marriage & Family Therapist | 106-b Olympia Dr., Warner Robins, GA 31093 | 2016-02-16 |
| 1780041822 | Neva Danielle Evans | Marriage & Family Therapist | 109 Osigian Blvd Ste 400, Warner Robins, GA 31088-8925 | 2016-01-20 |
| 1164824363 | Patti Mccurdy | Marriage & Family Therapist | 109 Constitution Dr Ste 100, Warner Robins, GA 31088-8046 | 2014-09-18 |
| 1942636162 | Carleen M. Forbes, Lmft | Marriage & Family Therapist | 320 Oakview Sq, Warner Robins, GA 31093-3119 | 2013-09-19 |
| 1417201609 | Susan G Melvin | Marriage & Family Therapist | 524 S Houston Lake Rd Ste G, Warner Robins, GA 31088-9027 | 2012-11-09 |
| 1518246065 | Holly Marie Stilwell | Marriage & Family Therapist | 109 Constitution Dr Ste 300, Warner Robins, GA 31088-8932 | 2011-08-15 |
| Find all providers in WARNER ROBINS | ||||
| City | WARNER ROBINS |
| Zip Code | 31088 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.