Healthcare Provider Details

I. General information

NPI: 1104746437
Provider Name (Legal Business Name): IJEOMA ADA BRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 COGBURN TER
RICHMOND VA
23234-6302
US

IV. Provider business mailing address

7013 COGBURN TER
RICHMOND VA
23234-6302
US

V. Phone/Fax

Practice location:
  • Phone: 210-505-6590
  • Fax:
Mailing address:
  • Phone: 210-505-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024198106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: