MEDICARE: BRIDGING THE GAP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	074-175	NC
2	320800000X	Mental Illness Community Based Residential Treatment Facility	074-175	NC
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YP2500X	Professional Counselor
5	106H00000X	Marriage & Family Therapist
6	103T00000X	Psychologist
7	104100000X	Social Worker
8	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578612370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGING THE GAP, LLC

Provider Business Mailing Address
First Line	:	205 PLAZA DR
Second Line	:	SUITE D
City	:	GREENVILLE
State	:	NC
Zip	:	27858-6752
Country	:	US
Telephone Number	:	252-758-1300
Fax Number	:	252-758-0015

Provider Business Practice Location Address
First Line	:	205 PLAZA DR
Second Line	:	SUITE D
City	:	GREENVILLE
State	:	NC
Zip	:	27858-6752
Country	:	US
Telephone Number	:	252-758-1300
Fax Number	:	252-758-0015

Authorized Official
Title or Position	:	QUALIFIED PROFESSIONAL
Name	:	MR. ANTHONY BARNETT
Credential	:
Telephone Number	:	252-758-1300

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/17/2011

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Directions to “BRIDGING THE GAP, LLC ” Practice Location

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