MEDICARE: A BRIGHTER DAY COUNSELING AND FAMILY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1205028081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BRIGHTER DAY COUNSELING AND FAMILY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 5338
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30916-5338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 AUGUSTA TECH DR
Second Line	:	SUITE 106
City	:	AUGUSTA
State	:	GA
Zip	:	30906-3300
Country	:	US
Telephone Number	:	706-833-3038
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CLYTE LYDIA PORTIS
Credential	:	LCSW
Telephone Number	:	706-833-3038

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	12/28/2007

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