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General NPI Number Information
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NPI Number | 1043455769
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Entity Type | Organization
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Legal Business Name | BRIDGE TO AWARENESS COUNSELING CENTER
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 5698 S HWY 85 SUITE 104
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-1465
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Country | US
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Telephone | 719-390-4652
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Fax | 719-690-4126
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Provider Business Mailing Address
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Address Line | 5698 S HWY 85 # 87 SUITE 104 AND 105
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-1465
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Country | US
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Telephone | 719-390-4652
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Fax | 719-390-5728
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEVE DARR
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Credential |
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Telephone | 719-471-2514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1110-01
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License Number State | CO
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