Provider Demographics
NPI:1215380613
Name:BRIDGE BUILDER COUNSELING SERVICES
Entity Type:Organization
Organization Name:BRIDGE BUILDER COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, BCPC
Authorized Official - Phone:334-467-6212
Mailing Address - Street 1:6725 TAYLOR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-6527
Mailing Address - Country:US
Mailing Address - Phone:334-467-6212
Mailing Address - Fax:270-738-4658
Practice Address - Street 1:6725 TAYLOR RIDGE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-6527
Practice Address - Country:US
Practice Address - Phone:334-467-6212
Practice Address - Fax:270-738-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1965251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL339006056Medicaid
AL339051148Medicaid