Bridging the Gap Wellness Center LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

BRIDGING THE GAP WELLNESS CENTER LLC

Practice address

2126 Highway 9 E Unit 5B
Longs, SC 29568-5725

Phone

(478) 361-2126

NPI assigned

Jan 19, 2023

Organization subpart

No

Name

Taraka Taylor-Moultrie, LISW-CPNPI 1720656291

Title

Director

Phone

(478) 361-2126

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taraka Taylor-Moultrie, LISW-CP

  • Clinical Social Worker
  • Longs, SC
  • NPI 1720656291
  NPD Authorized official

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 19, 2023.

{
    "created_epoch": "1674086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1194430660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 CHARTER DR UNIT B11",
            "city": "LONGS",
            "state": "SC",
            "postal_code": "295685833",
            "telephone_number": "478-361-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2126 HIGHWAY 9 E UNIT 5B",
            "city": "LONGS",
            "state": "SC",
            "postal_code": "295685725",
            "telephone_number": "478-361-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGING THE GAP WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-19",
        "last_updated": "2023-01-19",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "TAYLOR-MOULTRIE",
        "authorized_official_first_name": "TARAKA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "478-361-2126",
        "authorized_official_credential": "LISW-CP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tarakamoultrie@bridgingthegapwellnesscenter.com",
            "affiliation": "N",
            "endpointDescription": "HIPPA compliant email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2126 Highway 9 E Unit 5B",
            "city": "Longs",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295685725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Longs, SC
• Mental Health Clinic/Center (Including Community Mental Health Center) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.