Healthcare Provider Details

I. General information

NPI: 1952914632
Provider Name (Legal Business Name): BRIGHTER DAYZ, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6969 GALLANT CIR SE
MABLETON GA
30126-4683
US

IV. Provider business mailing address

6969 GALLANT CIR SE
MABLETON GA
30126-4683
US

V. Phone/Fax

Practice location:
  • Phone: 470-358-1990
  • Fax:
Mailing address:
  • Phone: 470-358-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELE A. DE LA CRUZ
Title or Position: FOUNDER/EXECUTIVE DIRECTOR
Credential: MASTERS DEGREE
Phone: 470-358-1990