MEDICARE: BRIDGE TO BALANCE BEHAVIORAL HEALTH

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

General Provider Information

NPI Number	:	1750230090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE TO BALANCE BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	4901 FITZHUGH AVE STE 203
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3531
Country	:	US
Telephone Number	:	804-441-8538
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 FITZHUGH AVE STE 203
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3531
Country	:	US
Telephone Number	:	804-441-8538
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	TONJANIKA BALLARD
Credential	:	PMHNP
Telephone Number	:	804-441-8538

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	01/28/2026

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