Organization
BRIDGING THE GAP WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARAKA TAYLOR-MOULTRIE LISW-CP (DIRECTOR)
(478) 361-2126
Entity
Organization
Contact information
Practice address
2126 HIGHWAY 9 E UNIT 5B, LONGS, SC 29568-5725
(478) 361-2126
Mailing address
780 CHARTER DR UNIT B11, LONGS, SC 29568-5833
(478) 361-2126
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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