Provider Demographics
NPI:1477436533
Name:COMMUNITY BRIDGE COUNSELING AND OUTREACH SERVICES, LLC
Entity type:Organization
Organization Name:COMMUNITY BRIDGE COUNSELING AND OUTREACH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNDAL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-434-3528
Mailing Address - Street 1:102 LANDINGS WAY APT 9C
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5327
Mailing Address - Country:US
Mailing Address - Phone:404-434-3528
Mailing Address - Fax:
Practice Address - Street 1:1300 3RD ST SW
Practice Address - Street 2:PMB# 174
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:904-420-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty