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General NPI Number Information
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NPI Number | 1528793189
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Entity Type | Organization
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Legal Business Name | BRIGHT PATHS BEHAVIORAL THERAPY LLC
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 11747 JEFFERSON AVE STE 3H
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4403
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Country | US
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Telephone | 631-901-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 3236 ST JAMES PARK
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1467
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | MELISSA MOCK
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Credential |
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Telephone | 631-901-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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