Provider Demographics
NPI:1205590478
Name:BRIDGING THE GAP COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:BRIDGING THE GAP COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TOUSSAINT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:718-809-4716
Mailing Address - Street 1:4 S ORANGE AVE # 509
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1702
Mailing Address - Country:US
Mailing Address - Phone:973-761-3536
Mailing Address - Fax:
Practice Address - Street 1:304 FULLER TER
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2414
Practice Address - Country:US
Practice Address - Phone:973-761-3536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health