Healthcare Provider Details

I. General information

NPI: 1497696769
Provider Name (Legal Business Name): BRIGHT STAR WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 WASHINGTON BLVD
BALTIMORE MD
21230-2332
US

IV. Provider business mailing address

772 WASHINGTON BLVD
BALTIMORE MD
21230-2332
US

V. Phone/Fax

Practice location:
  • Phone: 443-793-4646
  • Fax: 202-217-3181
Mailing address:
  • Phone: 443-793-4646
  • Fax: 202-217-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AYANNA BROWN
Title or Position: CEO
Credential:
Phone: 202-674-3700