Provider Demographics
NPI:1417580002
Name:SHENA MANNING, BRIGHTEN PATH COUNSELING,LLC
Entity Type:Organization
Organization Name:SHENA MANNING, BRIGHTEN PATH COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:770-609-0357
Mailing Address - Street 1:1007 MANSELL RD STE A PMB2020
Mailing Address - Street 2:STE A, PMB2020
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4805
Mailing Address - Country:US
Mailing Address - Phone:770-609-0357
Mailing Address - Fax:
Practice Address - Street 1:23 EASTBROOK BND STE C
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1565
Practice Address - Country:US
Practice Address - Phone:770-609-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1568093748OtherNPI