Provider Demographics
NPI:1508581026
Name:BRIGHT BEE-HAVIOR HEALTH LLC
Entity Type:Organization
Organization Name:BRIGHT BEE-HAVIOR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEDEST
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBRESELASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP/FNP
Authorized Official - Phone:571-338-2764
Mailing Address - Street 1:16236 CHASE EAGLE LANE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:571-338-2764
Mailing Address - Fax:
Practice Address - Street 1:800 CORPORATE DRIVE, SUITE 356
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:703-539-5411
Practice Address - Fax:703-621-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty