MEDICARE: AMBRIA VIRGINIA BRIGHTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1376385633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBRIA VIRGINIA BRIGHTS

Provider Business Mailing Address
First Line	:	9229 GLENWATER DR APT 515
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-7413
Country	:	US
Telephone Number	:	803-269-4630
Fax Number	:

Provider Business Practice Location Address
First Line	:	9229 GLENWATER DR APT 515
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-7413
Country	:	US
Telephone Number	:	803-269-4630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2024
Last Update Date	:	03/03/2026

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Directions to “ AMBRIA VIRGINIA BRIGHTS ” Practice Location

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