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General NPI Number Information
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NPI Number | 1164969036
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Entity Type | Organization
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Legal Business Name | BRIGHTER LIFE COUNSELING PLLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 201 NEW BRIDGE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4736
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Country | US
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Telephone | 336-755-6996
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Fax |
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Provider Business Mailing Address
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Address Line | 201 NEW BRIDGE ST
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4736
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Country | US
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Telephone | 336-755-6996
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. MARY FOLGER SUMMERLIN
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Credential | NCC, LPC, LCAS-A
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Telephone | 336-755-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCAS-21026
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 11015
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License Number State | NC
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