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General NPI Number Information
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NPI Number | 1396329223
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Entity Type | Organization
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Legal Business Name | BRIGHTSPARK THERAPY AND CONSULTING
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 801 N 27TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-6507
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Country | US
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Telephone | 804-668-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 9025 FOREST HILL AVE STE 2A
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-3025
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Country | US
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Telephone | 804-668-7220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLAIRE S FLANSBURG
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Credential | PHD, LCP
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Telephone | 804-668-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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