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General NPI Number Information
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NPI Number | 1245673995
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Entity Type | Organization
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Legal Business Name | BRIDGING THE GAPS TODAY, INC.
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Dates
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Enumeration Date | 04/12/2013
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 1135 VIRGINIA LEE LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-4874
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Country | US
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Telephone | 404-626-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 17 HAMPTON ST
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City | MCDONOUGH
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State | GA
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Zip | 30253-3159
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Country | US
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Telephone | 678-561-3043
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Fax | 866-539-7785
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Authorized Official
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Title or Position | CEO
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Name | DR. NATASHA GRIFFIN
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Credential | ED D, ST
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Telephone | 678-615-4820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12084654
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License Number State | GA
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