Organization
BRIDGING SEVENTEEN COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRI VERNESE JENKINS ED.D, LPC, NCC, ACS (EXECUTIVE DIRECTOR)
(706) 496-1010
Entity
Organization
Contact information
Practice address
3108 PEACH ORCHARD RD #6419, AUGUSTA, GA 30909-3090
(706) 496-1010
(877) 496-4637
Mailing address
4157 ELDERS DR, AUGUSTA, GA 30909-9145
(706) 496-1010
(877) 496-4637
Taxonomy
Speciality
Code
Description
License number
State
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
Primary
LPC006595
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003180029A
—
GA
01
—
671155
BCBS OF GA
GA
01
—
I534865
AETNA
GA
Enumeration date
06/22/2017
Last updated
06/22/2017
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