Provider Demographics
NPI: | 1184389082 |
---|---|
Name: | BRIDGING THE GAP COUNSELING SERVICES |
Entity type: | Organization |
Organization Name: | BRIDGING THE GAP COUNSELING SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DIANE |
Authorized Official - Middle Name: | JOY |
Authorized Official - Last Name: | GREEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 757-908-6082 |
Mailing Address - Street 1: | 11815 FOUNTAIN WAY STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWPORT NEWS |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23606-4448 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-908-6082 |
Mailing Address - Fax: | 757-734-9081 |
Practice Address - Street 1: | 11815 FOUNTAIN WAY STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | NEWPORT NEWS |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23606-4448 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-345-0706 |
Practice Address - Fax: | 757-734-9081 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-11-04 |
Last Update Date: | 2025-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |