Provider Demographics
NPI:1346753399
Name:THE BRIDGE COUNSELING AND CONSULTATION CENTER
Entity Type:Organization
Organization Name:THE BRIDGE COUNSELING AND CONSULTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JADA
Authorized Official - Middle Name:MCNAIR
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:478-957-4482
Mailing Address - Street 1:195 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-7415
Mailing Address - Country:US
Mailing Address - Phone:478-957-4482
Mailing Address - Fax:
Practice Address - Street 1:761 POPLAR ST STE 1K
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2061
Practice Address - Country:US
Practice Address - Phone:478-957-4482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0051451041C0700X
GAMSW004901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty