Provider Demographics
NPI:1235659780
Name:BRIGHT FUTURE COMMUNITY HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:BRIGHT FUTURE COMMUNITY HEALTH CARE SERVICES
Other - Org Name:BRIGHT FUTURE COMMUNITY HEALTH CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOBU
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CAC-AD
Authorized Official - Phone:443-912-4612
Mailing Address - Street 1:907 FOXWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5929
Mailing Address - Country:US
Mailing Address - Phone:443-413-8254
Mailing Address - Fax:
Practice Address - Street 1:40 S DUNDALK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-4267
Practice Address - Country:US
Practice Address - Phone:443-912-4612
Practice Address - Fax:877-288-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD065881200Medicaid