Healthcare Provider Details

I. General information

NPI: 1467365502
Provider Name (Legal Business Name): BRIGHT TRACK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SOUTH AVE
CARTERSVILLE GA
30120-3516
US

IV. Provider business mailing address

PO BOX 2463
CARTERSVILLE GA
30120-1692
US

V. Phone/Fax

Practice location:
  • Phone: 706-614-7048
  • Fax:
Mailing address:
  • Phone: 706-614-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH MOONEY
Title or Position: OWNER
Credential: LMFT
Phone: 706-614-7048