# BRIDGING THE GAP WITH LIFE SKILLS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LIFE SKILLS COUNSELING, PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659412997
- **Legal business name:** LIFE SKILLS COUNSELING, PLLC
- **Authorized official:** MISS TAMMY WORTHINGTON (QUALITY SERVIES DIRECTOR)
- **Authorized official phone:** (919) 833-2544

## Contact information

- **Practice address:** 2507 BLACKWOLF RUN LN, RALEIGH, NC 27604-5425
- **Practice address phone:** (919) 250-9546
- **Practice address fax:** (919) 250-7569
- **Mailing address:** 204 N PERSON ST, RALEIGH, NC 27601-1047
- **Mailing address phone:** (919) 833-2544
- **Mailing address fax:** (919) 833-0939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL092571 | NC | Yes |

## Other

- **Enumeration date:** 02/09/2007
- **Last updated:** 07/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6604129 | — | NC |