MEDICARE: BRIGHTER SPIRITS, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1720958325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER SPIRITS, PLLC

Provider Business Mailing Address
First Line	:	2100 COUNTRY CLUB RD APT 706
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-7309
Country	:	US
Telephone Number	:	317-469-3582
Fax Number	:	910-238-2521

Provider Business Practice Location Address
First Line	:	2100 COUNTRY CLUB RD APT 706
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-7309
Country	:	US
Telephone Number	:	317-469-3582
Fax Number	:	910-238-2521

Authorized Official
Title or Position	:	FOUNDER & CLINICAL DIRECTOR, BRIGHT
Name	:	MS. LATEEFA Z SHABAZZ
Credential	:	LCSW
Telephone Number	:	317-469-3582

Provider Enumeration Date	:	11/08/2025
Last Update Date	:	11/08/2025

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