Provider Demographics
NPI:1689769127
Name:THE BRIDGE OF THE CAROLINAS
Entity Type:Organization
Organization Name:THE BRIDGE OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:BILBO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-983-0911
Mailing Address - Street 1:P.O. BOX 1866
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-1866
Mailing Address - Country:US
Mailing Address - Phone:704-983-0911
Mailing Address - Fax:704-322-4039
Practice Address - Street 1:232 CONCORD RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4612
Practice Address - Country:US
Practice Address - Phone:704-985-3904
Practice Address - Fax:704-322-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006498Medicaid