Provider Demographics
NPI:1558904391
Name:BRIGHTER LIFE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:BRIGHTER LIFE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLHEMINA
Authorized Official - Middle Name:NANA D
Authorized Official - Last Name:AGORMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-523-3030
Mailing Address - Street 1:7911 BRAYGREEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5002
Mailing Address - Country:US
Mailing Address - Phone:301-523-3030
Mailing Address - Fax:301-927-5777
Practice Address - Street 1:7911 BRAYGREEN RD STE B
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5002
Practice Address - Country:US
Practice Address - Phone:301-523-3030
Practice Address - Fax:301-927-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health