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General NPI Number Information
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NPI Number | 1508581026
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Entity Type | Organization
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Legal Business Name | BRIGHT BEE-HAVIOR HEALTH LLC
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 800 CORPORATE DRIVE, SUITE 356
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 703-539-5411
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Fax | 703-621-1800
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Provider Business Mailing Address
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Address Line | 16236 CHASE EAGLE LANE
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City | WOODBRIDGE
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State | VA
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Zip | 22191
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Country | US
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Telephone | 571-338-2764
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | KEDEST GEBRESELASSIE
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Credential | PMHNP/FNP
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Telephone | 571-338-2764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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