Provider Demographics
NPI:1316600513
Name:BRIGHTSIDE BEHAVIORAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BRIGHTSIDE BEHAVIORAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, BCBA
Authorized Official - Prefix:
Authorized Official - First Name:WHITNI
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCANSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:678-510-6502
Mailing Address - Street 1:4443 GA HIGHWAY 219
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-4523
Mailing Address - Country:US
Mailing Address - Phone:762-261-0585
Mailing Address - Fax:706-441-3328
Practice Address - Street 1:4443 GA HIGHWAY 219
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-4523
Practice Address - Country:US
Practice Address - Phone:762-261-0585
Practice Address - Fax:706-441-3328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty