Healthcare Provider Details

I. General information

NPI: 1740198647
Provider Name (Legal Business Name): BRIGHTWELL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOSPITAL DR STE 223
GLEN BURNIE MD
21061-5707
US

IV. Provider business mailing address

7310 RITCHIE HWY STE 516
GLEN BURNIE MD
21061-3099
US

V. Phone/Fax

Practice location:
  • Phone: 443-221-2222
  • Fax: 844-708-1264
Mailing address:
  • Phone: 443-221-2222
  • Fax: 844-708-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DREW C FULLER
Title or Position: OWNER
Credential: MD
Phone: 844-387-7469