Healthcare Provider Details

I. General information

NPI: 1538816699
Provider Name (Legal Business Name): SUZANNA GRACE BRIGHT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BROOK PARK PL
FOREST VA
24551-2766
US

IV. Provider business mailing address

1312 KRISE CIR
LYNCHBURG VA
24503-2614
US

V. Phone/Fax

Practice location:
  • Phone: 434-533-1088
  • Fax: 434-664-1177
Mailing address:
  • Phone: 434-515-2128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011257
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: