Healthcare Provider Details

I. General information

NPI: 1821992819
Provider Name (Legal Business Name): MENDING BROKEN BRIDGES COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CS6091728
GREENSBORO NC
27409
US

IV. Provider business mailing address

3209 STONEBURG CT APT B
GREENSBORO NC
27409-8807
US

V. Phone/Fax

Practice location:
  • Phone: 252-327-2728
  • Fax:
Mailing address:
  • Phone: 252-327-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAKIRA MILLER
Title or Position: OWNER
Credential: LCMHC,LCAS
Phone: 252-327-2728