Provider Demographics
NPI:1578612370
Name:BRIDGING THE GAP, LLC
Entity Type:Organization
Organization Name:BRIDGING THE GAP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-1300
Mailing Address - Street 1:205 PLAZA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6752
Mailing Address - Country:US
Mailing Address - Phone:252-758-1300
Mailing Address - Fax:252-758-0015
Practice Address - Street 1:205 PLAZA DR
Practice Address - Street 2:SUITE D
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6752
Practice Address - Country:US
Practice Address - Phone:252-758-1300
Practice Address - Fax:252-758-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 101YP2500X, 103T00000X, 104100000X, 106H00000X
NC074-175251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6604195Medicaid
NC8301920BMedicaid