Bridging Seventeen Counseling Center, LLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

LPC006595 Issued in GA

Legal business name

BRIDGING SEVENTEEN COUNSELING CENTER, LLC

Practice address

3108 Peach Orchard Rd #6419
Augusta, GA 30909-3090

Phone

(706) 496-1010

Fax

(877) 496-4637

NPI assigned

Jun 22, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Terri Vernese Jenkins, ED.D, LPC, NCC, ACS

Title

Executive Director

Phone

(706) 496-1010

Specialties & licenses 3

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498089600000",
    "number": "1518487404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4157 ELDERS DR",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099145",
            "telephone_number": "706-496-1010",
            "fax_number": "877-496-4637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3108 PEACH ORCHARD RD #6419",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309093090",
            "telephone_number": "706-496-1010",
            "fax_number": "877-496-4637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGING SEVENTEEN COUNSELING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-22",
        "last_updated": "2017-06-22",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "VERNESE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "706-496-1010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D, LPC, NCC, ACS"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "LPC006595",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "LPC006595",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "GA",
            "license": "LPC006595",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "I534865",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003180029A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF GA",
            "identifier": "671155",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adolescent and Children Mental Health Clinic/Center in Augusta, GA
• Providers in Augusta, GA by specialty
• Adolescent and Children Mental Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2017; 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.