=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639032451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIGHT MIND BEHAVIORAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 N 8TH ST
-----------------------------------------------------
City | SMITHFIELD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27577-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-868-9583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 BATTEN POND RD
-----------------------------------------------------
City | SELMA
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27576-8204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-868-9583
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NONPROFIT OWNER
-----------------------------------------------------
Name | TATUM ABBYGALE GODWIN
-----------------------------------------------------
Credential | N/A
-----------------------------------------------------
Telephone | 919-868-9583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------