Provider Demographics
NPI:1093575805
Name:ENLIGHT MENTAL HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:ENLIGHT MENTAL HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ABERNATHY
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-337-3690
Mailing Address - Street 1:2335 WESTWOOD PINE DR
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1182
Mailing Address - Country:US
Mailing Address - Phone:804-317-6699
Mailing Address - Fax:844-742-6551
Practice Address - Street 1:2335 WESTWOOD PINE DR
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-1182
Practice Address - Country:US
Practice Address - Phone:804-317-6699
Practice Address - Fax:844-742-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty