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General NPI Number Information
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NPI Number | 1578272951
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Entity Type | Organization
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Legal Business Name | BRIGHTWELL HEALTH LLC
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 7310 RITCHIE HWY STE 516
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3099
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Country | US
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Telephone | 844-387-7469
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Fax | 844-708-1264
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Provider Business Mailing Address
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Address Line | 7310 RITCHIE HWY STE 516
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City | GLEN BURNIE
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State | MD
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Zip | 21061-3099
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Country | US
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Telephone | 844-387-7469
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Fax | 844-708-1264
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Authorized Official
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Title or Position | OWNER
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Name | DREW C FULLER
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Credential |
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Telephone | 844-387-7469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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