# BRIDGING SEVENTEEN COUNSELING CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518487404
- **Authorized official:** DR. TERRI VERNESE JENKINS ED.D, LPC, NCC, ACS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (706) 496-1010

## Contact information

- **Practice address:** 3108 PEACH ORCHARD RD \#6419, AUGUSTA, GA 30909-3090
- **Practice address phone:** (706) 496-1010
- **Practice address fax:** (877) 496-4637
- **Mailing address:** 4157 ELDERS DR, AUGUSTA, GA 30909-9145
- **Mailing address phone:** (706) 496-1010
- **Mailing address fax:** (877) 496-4637

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | LPC006595 | GA | — |
| 261QM0850X | Adult Mental Health Clinic/Center | LPC006595 | GA | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | LPC006595 | GA | Yes |

## Other

- **Enumeration date:** 06/22/2017
- **Last updated:** 06/22/2017