Provider Demographics
NPI:1467729855
Name:BRIDGING THE GAP OF NORTH CAROLINA
Entity Type:Organization
Organization Name:BRIDGING THE GAP OF NORTH CAROLINA
Other - Org Name:BRIDGING THE GAP OF AMERICA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-222-2928
Mailing Address - Street 1:3050 RIVERWOOD PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-6002
Mailing Address - Country:US
Mailing Address - Phone:704-222-2928
Mailing Address - Fax:
Practice Address - Street 1:3050 RIVERWOOD PKWY STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-6002
Practice Address - Country:US
Practice Address - Phone:704-691-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No305S00000XManaged Care OrganizationsPoint of Service