| NPI | 1013747120 |
|---|---|
| Doing Business As | BRIDGE OF LIGHT INC |
| Entity Type | Organization |
| Authorized Contact | XANDER D FAISON Owner/Clinical Director 443-991-1582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-05 |