MEDICARE: BRIDGE TO THRIVE, LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902734023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGE TO THRIVE, LLC

Provider Business Mailing Address
First Line	:	12320 OLD CANAL RD
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-6238
Country	:	US
Telephone Number	:	301-778-8534
Fax Number	:

Provider Business Practice Location Address
First Line	:	12320 OLD CANAL RD
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-6238
Country	:	US
Telephone Number	:	301-778-8534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. NATALYA SACKS
Credential	:	LCPC
Telephone Number	:	301-217-0855

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “BRIDGE TO THRIVE, LLC ” Practice Location

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