Provider Demographics
| NPI: | 1942822127 |
|---|---|
| Name: | THE BRIDGE CONSULTING GROUP, LLC |
| Entity Type: | Organization |
| Organization Name: | THE BRIDGE CONSULTING GROUP, LLC |
| Other - Org Name: | THE BRIDGE CONSULTING GROUP, LLC |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | ABA DIRECTOR/CEO |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | VALENCIA |
| Authorized Official - Middle Name: | BUTLER |
| Authorized Official - Last Name: | CHURCH-WILLIAMS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | EDD, LBA, QBA |
| Authorized Official - Phone: | 919-491-8611 |
| Mailing Address - Street 1: | 3790 GUESS RD STE 102 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DURHAM |
| Mailing Address - State: | NC |
| Mailing Address - Zip Code: | 27705-6916 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 984-244-8642 |
| Mailing Address - Fax: | 919-937-2046 |
| Practice Address - Street 1: | 3790 GUESS RD STE 102 |
| Practice Address - Street 2: | |
| Practice Address - City: | DURHAM |
| Practice Address - State: | NC |
| Practice Address - Zip Code: | 27705-6916 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 984-244-8642 |
| Practice Address - Fax: | 919-937-2046 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-05-11 |
| Last Update Date: | 2023-07-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
| No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | Group - Multi-Specialty | |
| No | 343800000X | Transportation Services | Secured Medical Transport (VAN) | Group - Multi-Specialty | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Multi-Specialty | |
| No | 344600000X | Transportation Services | Taxi | Group - Multi-Specialty | |
| No | 347C00000X | Transportation Services | Private Vehicle | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 10771 | Other | QUALIFIED APPLIED BEHAVIOR ANALYSIS CREDENTIALING BOARD (QABA) | |
| NC | 2346 | Other | NORTH CAROLINA PSYCHOLOGY BOARD |
| 11685 | Other | QUALIFIED AUTISM SERVICES PROVIDER-SUPERVISOR | |
| NC | 1659 | Other | NORTH CAROLINA PSYCHOLOGY BOARD |
| VA | 0133002469 | Other | COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS |
| NC | A14394 | Other | NORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELOR |
