Provider Demographics
NPI:1093233264
Name:A BRIDGE TO ACHIEVEMENT NC, LLC
Entity Type:Organization
Organization Name:A BRIDGE TO ACHIEVEMENT NC, LLC
Other - Org Name:A BRIDGE TO ACHIEVEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MAYMAN
Authorized Official - Last Name:ALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:336-565-6363
Mailing Address - Street 1:1420 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1470
Mailing Address - Country:US
Mailing Address - Phone:336-565-6363
Mailing Address - Fax:
Practice Address - Street 1:1420 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1470
Practice Address - Country:US
Practice Address - Phone:336-565-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXXXXXXOtherNA