Healthcare Provider Details

I. General information

NPI: 1417874165
Provider Name (Legal Business Name): BRIDGING THE GAP COUNSELING & WELLNESS, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12321 MAGNOLIA AVE STE D
RIVERSIDE CA
92503-4706
US

IV. Provider business mailing address

PO BOX 2312
PERRIS CA
92572-2312
US

V. Phone/Fax

Practice location:
  • Phone: 909-648-4457
  • Fax:
Mailing address:
  • Phone: 909-648-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENESHA BEATRICE MITCHELL
Title or Position: OWNER
Credential: DSW, LMFT
Phone: 909-648-4457