Healthcare Provider Details

I. General information

NPI: 1063170405
Provider Name (Legal Business Name): BRIGHT MOMENTS THERAPY & CONSULTATION SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 SACRAMENTO ST
BERKELEY CA
94702-2726
US

IV. Provider business mailing address

PO BOX 71384
OAKLAND CA
94612-7584
US

V. Phone/Fax

Practice location:
  • Phone: 510-593-8988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. NAKIA LINZIE-SHAVERS
Title or Position: CEO
Credential: LCSW
Phone: 510-593-8988