Healthcare Provider Details

I. General information

NPI: 1295524510
Provider Name (Legal Business Name): BRIGHT PATH CREATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 GARLAND AVE APT 602
TAKOMA PARK MD
20912-6868
US

IV. Provider business mailing address

8221 GARLAND AVE APT 602
TAKOMA PARK MD
20912-6868
US

V. Phone/Fax

Practice location:
  • Phone: 410-935-0561
  • Fax:
Mailing address:
  • Phone: 410-935-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA C GOSS
Title or Position: LICENSED CLINICAL PROF. COUNSLR
Credential: LCPC, LCPAT
Phone: 410-935-0561