Provider Demographics
NPI:1104265305
Name:BRIDGING THE G.A.P.P. THROUGH AMBITION, PASSION, AND POSITIVITY, LLC
Entity type:Organization
Organization Name:BRIDGING THE G.A.P.P. THROUGH AMBITION, PASSION, AND POSITIVITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:MCCRAY
Authorized Official - Last Name:RUDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-210-6257
Mailing Address - Street 1:324 S ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2645
Mailing Address - Country:US
Mailing Address - Phone:336-500-0060
Mailing Address - Fax:336-500-0061
Practice Address - Street 1:324 S ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2645
Practice Address - Country:US
Practice Address - Phone:336-500-0060
Practice Address - Fax:336-500-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health