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General NPI Number Information
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NPI Number | 1093575805
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Entity Type | Organization
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Legal Business Name | ENLIGHT MENTAL HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 12/22/2024
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Provider Practice Location Address
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Address Line | 1231 ALVERSER DR STE 110
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-2650
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Country | US
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Telephone | 804-217-1840
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Fax | 844-742-6551
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Provider Business Mailing Address
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Address Line | 1231 ALVERSER DR STE 110
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-2650
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Country | US
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Telephone | 804-217-1840
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Fax | 844-742-6551
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Authorized Official
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Title or Position | FOUNDER
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Name | LAURA ABERNATHY BASS
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Credential | NP
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Telephone | 804-337-3690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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