MEDICARE: BRIGHTER PERSPECTIVES COUNSELING AND CONSULTATION

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	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1730786146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER PERSPECTIVES COUNSELING AND CONSULTATION

Provider Business Mailing Address
First Line	:	3020 PROSPERITY CHURCH RD STE I
Second Line	:	#945
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8100
Country	:	US
Telephone Number	:	980-689-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 PROSPERITY CHURCH RD STE I
Second Line	:	#945
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8100
Country	:	US
Telephone Number	:	980-689-1809
Fax Number	:	980-326-2408

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	CONICKA L WIGGINS
Credential	:	LCSW, LCAS
Telephone Number	:	980-689-1809

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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