Provider Demographics
NPI:1447389382
Name:BRIDGE TO AWARENESS COUNSELING CENTER, INC
Entity type:Organization
Organization Name:BRIDGE TO AWARENESS COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:DARR
Authorized Official - Suffix:
Authorized Official - Credentials:CAC III
Authorized Official - Phone:719-471-2514
Mailing Address - Street 1:129 W COSTILLA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3813
Mailing Address - Country:US
Mailing Address - Phone:719-471-2514
Mailing Address - Fax:
Practice Address - Street 1:129 W COSTILLA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3813
Practice Address - Country:US
Practice Address - Phone:719-471-2514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1110-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95527338Medicaid